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Updated: Jul 15, 2026
Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
A randomized multicenter study of remifentanil compared with halothane in neonates and infants undergoing
P J Davis1, J Galinkin, F X McGowan
1Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213-2583, USA. davispj@anes.upmc.edu
Insights
Remifentanil anesthesia is comparable to halothane for infant pyloromyotomy, showing similar hemodynamic stability and recovery. However, remifentanil may reduce the risk of postoperative apnea in infants under two months old.
Area of Science:
- Anesthesiology
- Pediatric Surgery
Background:
- Pyloric stenosis can lead to hemodynamic instability and postoperative apnea in infants.
- Evaluating anesthetic techniques is crucial for optimizing outcomes in pediatric surgical patients.
Purpose of the Study:
- To compare the hemodynamic response and recovery profile of remifentanil versus halothane in infants undergoing pyloromyotomy.
- To assess the incidence of postoperative apnea associated with each anesthetic agent.
Main Methods:
- A multicenter, randomized controlled trial comparing remifentanil and halothane anesthesia in infants undergoing pyloromyotomy.
- Patients received either remifentanil or halothane as maintenance anesthesia after initial induction.
- Hemodynamic parameters, pneumograms, and postanesthesia care unit (PACU) recovery data were collected and analyzed.
Main Results:
- No significant differences were observed in intraoperative hemodynamics, extubation times, PACU discharge times, pain medication requirements, or adverse events between the remifentanil and halothane groups.
- No patient receiving remifentanil with a normal preoperative pneumogram developed an abnormal postoperative pneumogram.
- Three patients receiving halothane with normal preoperative pneumograms had abnormal postoperative pneumograms.
Conclusions:
- Remifentanil anesthesia is a safe and effective alternative to halothane for pyloromyotomy in infants.
- Ultra-short-acting opioids like remifentanil may be particularly beneficial for infants under two months old when early tracheal extubation is planned, potentially reducing the risk of postoperative apnea.
Unlabelled:
Pyloric stenosis is sometimes associated with hemodynamic instability and postoperative apnea. In this multicenter study we examined the hemodynamic response and recovery profile of remifentanil and compared it with that of halothane in infants undergoing pyloromyotomy. After atropine, propofol, and succinylcholine administration and tracheal intubation, patients were randomized (2:1 ratio) to receive either remifentanil with nitrous oxide and oxygen or halothane with nitrous oxide and oxygen as the maintenance anesthetic. Pre- and postoperative pneumograms were done and evaluated by an observer blinded to the study. Intraoperative hemodynamic data and postanesthesia care unit (PACU) discharge times, PACU recovery scores, pain medications, and adverse events (vomiting, bradycardia, dysrhythmia, and hypoxemia) were recorded by the study's research nurse. There were no significant differences in patient age or weight between the two groups. There were no significant differences in hemodynamic values between the two groups at the various intraoperative stress points. The extubation times, PACU discharge times, pain medications, and adverse events were similar for both groups. No patient anesthetized with remifentanil who had a normal preoperative pneumogram had an abnormal postoperative pneumogram, whereas three patients with a normal preoperative pneumogram who were anesthetized with halothane had abnormal pneumograms after.
Implications:
The use of ultra-short-acting opioids may be an appropriate technique for infants less than 2 mo old when tracheal extubation after surgery is anticipated.
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