Related Experiment Video
Updated: Aug 19, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Remifentanil use in children undergoing congenital heart surgery for left-to-right shunt lesions
Elif A Akpek1, Cigdem Erkaya, Asli Donmez
1Department of Anesthesiology, Başkent University, Ankara, Turkey. elifakpek@baskent-ank.edu.tr
Insights
Remifentanil and fentanyl showed no significant clinical differences in hemodynamic or respiratory effects during pediatric cardiac surgery for left-to-right shunts. Both opioids are safe for managing hemodynamics and respiratory variables in these young patients.
Area of Science:
- Anesthesiology
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Pediatric cardiac surgery for left-to-right shunts often involves complex hemodynamic and respiratory management.
- Opioid selection is critical for maintaining stability during and after surgery.
- Remifentanil and fentanyl are commonly used anesthetics, but their comparative effects in this specific population require detailed analysis.
Purpose of the Study:
- To compare the intraoperative and early postoperative hemodynamic and respiratory effects of remifentanil versus fentanyl in pediatric patients undergoing cardiac surgery for left-to-right shunts.
- To evaluate the safety and efficacy of these two opioids in managing vital signs in this vulnerable patient group.
Main Methods:
- Prospective, randomized, controlled study conducted at a university hospital.
- 18 children (3 months to 6 years) received remifentanil, while 15 received fentanyl for intraoperative anesthesia during cardiac surgery for left-to-right intracardiac shunts.
- Hemodynamic (mean arterial pressure, heart rate, pulmonary artery pressure) and respiratory (airway pressure, oxygen saturation) variables were monitored.
Main Results:
- Mean arterial pressures were higher in the remifentanil group post-surgery (p<0.05).
- No significant differences were observed in heart rates, pulmonary artery pressures, or airway pressures between the groups.
- Peripheral oxygen saturation varied, with lower pre-bypass values and higher intensive care unit values in the remifentanil group (p<0.05). Transient desaturation occurred more frequently with remifentanil post-protamine (p=0.029), but without hemodynamic compromise.
Conclusions:
- No clinically significant differences in hemodynamic or respiratory parameters were found between remifentanil and fentanyl during the intraoperative period and the first 24 hours postoperatively.
- Both remifentanil and fentanyl appear to be suitable anesthetic agents for pediatric patients undergoing surgical repair of left-to-right shunts.
- The study supports the use of either opioid for maintaining hemodynamic and respiratory stability in this patient population.
Objective:
The authors compared the effects of remifentanil with fentanyl on the hemodynamic and respiratory variables in children with left-to-right shunting and pulmonary hypertension.
Design:
A prospective, randomized, and controlled design.
Setting:
University hospital.
Participants:
Children aged between 3 months and 6 years undergoing pediatric cardiac surgery for correction of left-to-right intracardiac shunting.
Interventions:
Children were assigned to 1 of the 2 opioids for intraoperative use. Fentanyl was given as a 20 microg/kg intravenous bolus followed by infusion at a rate of 20 microg/kg/h in group 1 (control, n=15), and remifentanil was given as a 2 microg/kg intravenous bolus followed by infusion at a rate of 2 microg/kg/min in group 2 (n=18).
Measurements And Main Results:
Mean arterial pressures at 30 to 40 minutes postbypass and the first 2 hours postsurgery were higher in the remifentanil group (p<0.05). Heart rates, pulmonary artery pressures, and airway pressures did not differ at any time between groups. Peripheral oxygen saturation values were lower at 30 and 45 minutes in the prebypass period and higher at 1 to 4 hours in the intensive care unit in the remifentanil group (p<0.05). After protamine administration, transient peripheral oxygen desaturation was observed with 10 children in the remifentanil group and with 3 children in the fentanyl group without any hemodynamic deterioration (p=0.029).
Conclusion:
There were no clinically important differences in hemodynamic and respiratory measurements intraoperatively and during the initial 24 hours postoperatively between fentanyl and remifentanil in pediatric patients undergoing surgical repair of defects with left-to-right shunts.
Related Concept Videos
01:24Parenteral Anesthetics: Overview
01:20Inhalational Anesthetics: Overview