A Comparison Of Fentanyl And Remifentanil For Fast Track Paediatric Cardiac Anaesthesia

Background:With the improvements of perioperative strategies for children with congenital heart disease,the focus in now has directed towards provision of cost-effective patient care.Early extubation is necessary element of fast tracking cardiac anaesthesia.How to achieve early extubation without compromising the patients' anaesthesia depth is gaining anesthesiologists' attention.Objective:To evaluate the efficacy and safety of anesthetic technique based on either fentanyl or remifentanil for early extubation after paediatric cardiac surgery.The circulation stability,stress responses,complications were compared.Methods:37 patients with atrial septal defect(ASD) or simple ventricular septal defect(VSD) were randomly assigned to groupⅠwith bolus infusion of 5,2.5,2.5μg·kg^-1 fentanyl,groupⅡand groupⅢwith continuous remifentanil infusion of 0.25μg·kg^-1·min^-1 and 0.50μg·kg^-1·min^-1.Arterial pressure,heart rate,Bispectral index(BIS),endtidal concentration of sevoflurane were recorded at conscious loss as baseline(T0),post intubation(T1), skin incision(T2),sternotomy(T3),establish of CPB(T4),10min of CPB(T5),5 min after rewarmed(T6),end of CPB(T7),10min after CPB(T8),sternal wires(T9),end of operation(T10),extubation(T11),0.5 and 2 hours after extubation(T12 and T13). Serum norepinephrine(NE),cortisol(COR),glucose(BG),lactate acid(LAC) levels were measured at T0,T3,T6,T12,T13.Results:All the patients were successfully extubated in the OR.Heart rate increased significantly in three groups after extubation while blood pressure only increased in groupⅡwith more vasodilator and sedative treatments.Serum NE level in three groups was constant except groupⅠat T6.Serum level of NE,COR,and LAC in groupⅡat T13 were significantly higher than the other two groups.The level of COR,BG and LAC in groupⅢat T6 were significantly lower than the other two groups.No significant differences were observed in BIS over time,and there was significant negative correlation between BIS and endtidal concentration of sevoflurane in all three groups.The mean BIS at the end of surgery and extubation was 73 and 80 for all groups.Conclusion:All the patients can be successfully extubated in the OR with 10μg·kg^-1 fentanyl,0.25μg·kg^-1·min^-1 and 0.50μg·kg^-1·min^-1 remifentanil while 0.50μg·kg^-1·min^-1 remifentanil may attenuate the stress responses better and maintained stabler internal environment.BIS monitor can evaluate the anesthetic level and guide extubation.