piperidines and Craniosynostoses

The aim of the present study was to compare the efficacy of isoflurane-remifentanil and sevoflurane-remifentanil combinations during neurosurgical correction craniosynostosis.. Twenty-two infants with craniosynostosis received a slow bolus of remifentanil followed by continuous infusion. The infants were randomly divided into two groups: remifentanil followed by sevoflurane (the 'sevoflurane group'), and remifentanil followed by isoflurane (the 'isoflurane group'). We monitored electrocardiogram (ECG), heart rate (HR), invasive arterial blood pressure (IABP), pulse oximetry saturation (SpO(2)), endtidal CO(2) (P(ECO(2))), inspired fraction of oxygen (FiO(2)) and endtidal volatile agent (PE volatile agent) at 12 time points, from the beginning of surgery (T0) until the cessation of drugs (T11). The volatile agent was stopped prior to skin suture and the remifentanil infusion after skin closure. Subsequently, we evaluated recovery time of spontaneous breathing and spontaneous eye opening and time of extubation at 5, 10, and 15 min after extubation, the Steward Recovery Score (SRS) was assessed. Patients were then transferred to the Pediatric Intensive Care Unit (PICU).. During the surgical procedure the hemodynamic parameters between the two groups did not show statistically significant differences. There were also no significant differences in terms of awakening time or SRS.. The rapid recovery of the children (confirmed by their high values of SRS) makes it possible to reliably assess the patient's neurological condition immediately after surgery.

Topics: Anesthesia Recovery Period; Anesthetics, Combined; Anesthetics, Inhalation; Anesthetics, Intravenous; Blood Pressure; Carbon Dioxide; Craniosynostoses; Electrocardiography; Female; Follow-Up Studies; Heart Rate; Humans; Infant; Intubation, Intratracheal; Isoflurane; Male; Methyl Ethers; Oxygen; Oxygen Consumption; Piperidines; Prospective Studies; Remifentanil; Respiration; Sevoflurane; Treatment Outcome

Topics: Analgesics; Anesthetics, Inhalation; Anesthetics, Intravenous; Anesthetics, Local; Bupivacaine; Child; Child, Preschool; Clonidine; Craniosynostoses; Female; Humans; Infant; Male; Methyl Ethers; Nerve Block; Nitrous Oxide; Piperidines; Propofol; Remifentanil; Retrospective Studies; Scalp; Sevoflurane

Topics: Anesthetics, Intravenous; Craniosynostoses; Humans; Infant; Infant, Newborn; Infusions, Intravenous; Piperidines; Remifentanil

Topics: Analgesics, Opioid; Craniosynostoses; Humans; Intraoperative Care; Neurosurgical Procedures; Pain, Postoperative; Piperidines; Remifentanil; Research Design

Few studies on analgesia with remifentanil (Rf) in children are available, and there are no data on the use of this drug in pediatric neurosurgery. Rf is a new mu-receptor opioid agonist, acting through the activation of pain inhibitory mechanisms. We conducted a prospective trial on the analgesic effects of Rf in 20 children less than 1 year of age undergoing a neurosurgical procedure for craniosynostosis repair. Rf was administered at doses of 0.25 microgram/kg/min, by continuous infusion, 1 h after admission to the pediatric intensive care unit (PICU). The treatment was prolonged for 12 h after the operation. The postoperative pain was evaluated in our PICU, comparing the changing of behavioral (AFS and CHEOPS score) and hemodynamic (heart rate, respiratory rate, systolic and diastolic blood pressure, oxygen saturation, O(2) and CO(2) partial pressure) parameters, before and after treatment with Rf. This drug showed a satisfactory pain control in all the children treated. No significant side effects were noticed, except for one episode of urinary retention. In conclusion, Rf appears to be safe and effective for the treatment of acute pain in the very young child submitted to craniosynostosis repair.

Topics: Age Factors; Analgesics, Opioid; Brain; Cerebrovascular Circulation; Craniosynostoses; Drug Administration Schedule; Female; Humans; Infant; Intracranial Pressure; Male; Neurosurgical Procedures; Pain Measurement; Pain, Postoperative; Piperidines; Remifentanil; Treatment Outcome