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Remifentanil versus fentanyl for esophagogastroduodenoscopy in children

Irina Hirsh1, Aaron Lerner, Ilia Shnaider

  • 1Department of Anesthesiology, Critical Care and Pain Medicine, Lady Davis Carmel Medical Center, Haifa, Israel. hi767682@yahoo.com

Journal of Pediatric Gastroenterology and Nutrition
|September 3, 2010
PubMed

Insights

Remifentanil combined with propofol offers shorter sedation and fewer adverse effects in pediatric endoscopy compared to fentanyl. However, remifentanil use requires careful monitoring due to increased respiratory depression risk.

Area of Science:

  • Pediatric Anesthesiology
  • Gastroenterology
  • Pharmacology

Background:

  • Sedation is crucial for pediatric procedures like esophagogastroduodenoscopy.
  • Propofol is commonly used, but optimal adjuncts for analgesia and sedation are debated.
  • Fentanyl and remifentanil are potent opioids used in procedural sedation.

Purpose of the Study:

  • To compare the efficacy and safety of propofol-remifentanil versus propofol-fentanyl sedation in pediatric outpatients undergoing esophagogastroduodenoscopy.
  • To evaluate cardiorespiratory parameters, sedation levels, adverse events, and recovery times.

Main Methods:

  • A randomized controlled trial involving 42 pediatric outpatients undergoing esophagogastroduodenoscopy.
  • Participants received either propofol with fentanyl (Group F) or propofol with remifentanil (Group R).
  • Key outcomes included cardiorespiratory monitoring, sedation assessment, adverse events, and time to awakening.

Main Results:

  • No significant hemodynamic changes were observed between groups.
  • Remifentanil group (Group R) experienced more frequent apnea and hypoxemia (SaO2 <90%) compared to the fentanyl group (Group F).
  • Group R showed significantly shorter awakening times (9.5 vs. 16.5 minutes) and received lower total propofol doses, with fewer delayed adverse effects.

Conclusions:

  • Propofol-remifentanil provides effective sedation with faster recovery and fewer delayed adverse effects than propofol-fentanyl in pediatric endoscopy.
  • Increased respiratory depression risk with remifentanil necessitates vigilant monitoring by experienced anesthesiologists.
  • Remifentanil offers a potentially advantageous sedation profile for pediatric procedures when managed appropriately.
Abstract

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