Comparison Of Fentanyl,Sufentanil And Remifentanil For Transthoracic Closure Of Ventricular Septal Defects In Pediatric Patients

Objective:To collect the anesthetic schemes of fentanyl,sufentanil and remifentanil used in transthoracic small incision closure of congenital ventricular septal defect(VSD)in our hospital retrospectively,compare the anesthetic effects of fentanyl,sufentanil and remifentanil,and evaluate the safety and efficacy of fast track anesthesia in transthoracic small incision closure of congenital ventricular septal defect(VSD)in children.Methods: From August 2016 to August 2018,312 children undergoing transthoracic closure of ventricular septal defect(VSD)were divided into three groups,according to the different opioid drugs used in our hospital,group F(fentanyl group),group R(remifentanil group),and group S(sufentanil group).Group F had 60 cases,group R included 150 cases,group S was 102 cases.The data of three groups were collected:(1)Preoperative general information;(2)The mean arterial blood pressure and heart rate of before and after induction of general anesthesia,skin incision,thoracotomy,thoracic closure,sew skin,and 1 h,4 h,8 h,24 h after extubation.(3)CRIES(Crying,Requires O2 turation,Increased vital signs,Expression,Sleeplessness)score at 1 h,4 h,8 h,24 h after extubation.Evaluated by crying,breathing,circulation,expression and sleep,the higher the score,the more severe the pain.(4)Call for eye-opening time,extubation time,ICU stay time,and postoperative hospital stay.(5)Postoperative complications such as pulmonary infection laryngospasm bronchospasm and so on.Statistical analysis was carried out.Results: The age and body weight of group R was larger than that of group F and group F was greater than that of group S.But before induction,there was no significant difference in blood pressure and heart rate among the three groups(P > 0.05).After induction of general anesthesia,skin incision,thoracotomy,closure,suture,extubation and after extubation 1 h,2 h,there was no significant difference in mean arterial blood pressure and heart rate among the three groups(P > 0.05).The mean arterial blood pressure and heart rate in group S and R were lower than those in group F at 4h after extubation(P < 0.05).At 8h and 24 h after extubation,the mean arterial blood pressure and heart rate in group R were significantly lower than those in group S and group F(P < 0.05),but there was no significant difference between group S and group F(P > 0.05).The pain score in group R was significantly lower than that in group S(P < 0.05),while that in group S was lower than that in group F(P < 0.05).The time of calling open eyes,extubation of trachea catheter,ICU stay and the days of hospitalization after operation in group R were lower than those in other two groups(P < 0.05),and group S were lower than group F,there was a significant difference between them(P < 0.05).In terms of postoperative complications,the incidence of pulmonary infection and laryngeal edema in group R was lower than that in group S and group S was lower than that in group F(P < 0.017).However,the incidence of bronchospasm in group R and group S had no significant difference(P > 0.017)and there was significant difference between group R and group F and S(P < 0.017).Group F was significantly higher than group R and S.Conclusion: Fast-track anesthesia with remifentanil for transthoracic closure of ventricular septal defects in pediatric patients was save,effective,economic.It is worth popularizing widely in clinic,so as to benefit more children.