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One center's experience with remifentanil infusions for pediatric cardiac catheterization
A Dönmez1, A Kizilkan, H Berksun
1Department of Anesthesiology, University of Başkent, School of Medicine, Kavaklidere, 06690 Ankara, Turkey. aslidonmez@hotmail.com
Insights
Remifentanil infusion offers stable hemodynamics and rapid recovery for pediatric cardiac catheterization. It is a viable alternative when other sedatives are contraindicated, though additional medications may be needed for optimal sedation.
Area of Science:
- Anesthesiology
- Pediatric Cardiology
Background:
- Pediatric cardiac catheterization requires effective sedation and analgesia.
- Traditional sedatives may have contraindications in certain pediatric populations.
Purpose of the Study:
- To evaluate the efficacy of remifentanil infusion for sedation and analgesia during pediatric cardiac catheterization.
Main Methods:
- A prospective study involving 55 children (2 months to 12 years) undergoing cardiac catheterization.
- Remifentanil infusion initiated at 0.1 microg/kg/min, with continuous monitoring of vital signs and sedation levels.
- Assessment of adverse events such as apnea, vomiting, and pruritus, and evaluation of recovery time.
Main Results:
- Remifentanil infusion maintained stable hemodynamics (blood pressure, heart rate, SpO2, respiratory rate) throughout the procedure.
- Sedation scores significantly improved after 30 minutes of infusion.
- While 23 patients achieved satisfactory sedation, 32 required additional sedatives (midazolam or midazolam plus ketamine).
- Rapid recovery observed with a mean time of 2.04 minutes to reach a recovery score of >=5.
- Adverse events were minimal, including three instances of apnea, one case of vomiting, and one of pruritus.
Conclusions:
- Remifentanil infusion is a suitable alternative for sedation in pediatric cardiac catheterization, especially when other agents are contraindicated.
- The drug provides stable hemodynamics and allows for rapid patient recovery.
- Careful titration and potential need for adjunct medications should be considered for optimal sedation.
Objective:
To investigate the efficacy of a remifentanil infusion for pediatric cardiac catheterization.
Design:
Prospective.
Setting:
University hospital.
Participants:
Children undergoing cardiac catheterization (n = 55).
Interventions:
All patients (age range, 2 months to 12 years) were premedicated with an oral mixture of hydroxyzine and midazolam 60 minutes before the procedure. A remifentanil infusion was initiated at 0.1 microg/kg/min before the start of cardiac catheterization. Noninvasive systolic blood pressure, heart rate, oxygen saturation (SpO(2)), respiratory rate, and sedation score were recorded before the remifentanil infusion and every 15 minutes thereafter throughout the procedure. Episodes of apnea, vomiting, pruritus, and muscle rigidity and recovery time were noted.
Measurements And Main Results:
There were no significant changes in systolic blood pressure, heart rate, SpO(2), or respiratory rate during the procedure. The sedation scale scores at 30, 45, 60, 75, and 90 minutes of remifentanil infusion were significantly lower than the scores recorded at baseline and 15 minutes. In 23 patients, the remifentanil infusion maintained a satisfactory level of sedation, but 32 patients required additional drugs (18 received midazolam, and 14 received midazolam plus ketamine). Recovery was rapid after the remifentanil infusion was discontinued, with a mean time of 2.04 +/- 2.32 minutes to reach a recovery score of > or =5. Three patients experienced apnea after bolus doses of remifentanil, 1 patient vomited, and 1 patient complained of pruritus.
Conclusion:
In pediatric cases in which other intravenous analgesics and sedatives are contraindicated, remifentanil infusion appears to be a suitable alternative based on its associated rapid recovery and stable hemodynamics.