Glycopyrrolate during sevoflurane–remifentanil-based anaesthesia for cardiac catheterization of children with congenital heart disease

Effects of Remifentanil and Sufentanil Anesthesia on Cardiac Function and Serological Parameters in Congenital Heart Surgery

In this study, we have investigated feasibility of remifentanil and sufentanil anesthesia in children with congenital heart disease surgery and its effects on cardiac function and serological parameters. For this purpose, a retrospective study was conducted on 120 children with congenital heart disease who underwent repair of ventricular septum or atrial septum in our hospital, specifically from January 2016 to January 2018, and 60 patients in each group were randomly divided into the control and treatment groups, respectively. The control group was anesthetized with sufentanil, and the treatment group was anesthetized with remifentanil. The heart function, serological indexes, and adverse reactions were observed and compared. We have observed that there was no significant difference in HR levels between these groups (P > 0.05), but SDP and DBP values of the two groups were decreased after anesthetic induction (P < 0.05). ACH, cortisol, and lactic acid in the treatment group were significantly lower than those in the control group, and the difference was statistically significant (P < 0.05). The incidence of bradycardia, nausea and vomiting, hypotension, muscle rigidity, and respiratory depression in the treatment group was 16.67% lower than that in the control group (P < 0.05). Remifentanil has less influence on hemodynamics and a better analgesic effect than fentanyl in inhibiting stress response in congenital heart surgery, which provides reference and basis for children congenital heart surgery.

Effects of different plasma target concentrations of remifentanil on the MACBAR of sevoflurane in children with laparoscopic surgery

Background

To investigate the effects of different plasma target concentrations of remifentanil on the minimum alveolar concentration (MAC) for blocking adrenergic response (BAR) of sevoflurane in children with laparoscopic herniorrhaphy.

Methods

Seventy-five children with 3-7 years old scheduled for laparoscopic herniorrhaphy were randomly divided into group R₀, group R_1, and group R₂ according to different remifentanil plasma target concentration (0, 1, and 2 ngml^-1), respectively. The MAC_BAR of sevoflurane was determined by the up-and-down and sequential method in each group. The concentrations of epinephrine and noradrenaline were also determined at corresponding time points.

Results

A total of 52 child patients were used among the anticipated 75 patients. In groups R₀, R_1, and R₂, the MAC_BAR of sevoflurane was (3.29 ± 0.17) %, (2.12 ± 0.10) % and (1.29 ± 0.11) %, respectively, and a significant difference was found among the three groups (P<0.05). The changes of epinephrine and noradrenaline concentrations in each group before and after insufflation of carbon dioxide pneumoperitoneum showed no significant differences.

Conclusion

Remifentanil by target-controlled infusion can effectively reduce the MAC_BAR of sevoflurane during laparoscopic surgery in children. At a similar effect of MAC_BAR, both the changes of epinephrine and noradrenaline concentrations are not affected by the infusion of different remifentanil target concentrations.

Trial registration

The trial was registered at http://www.chictr.org.cn(ChiCTR1800019393, 8, Nov, 2018).

Hypoglycemia associated with dexmedetomidine overdose in a child?

The case of an asymptomatic 20 month-old, 10.7-kg girl, scheduled for interventional cardiac catheterization to close a patent ductus arteriosus, who suffered significant hypoglycemia possibly related in part to an overdose of dexmedetomidine, is reported. An infusion of dexmedetomidine was started using a programmable syringe pump at the intended administration rate of one mcg/kg/hr, but was actually incorrectly programmed at the rate of one mcg/kg/min. The infusion continued for 36 minutes until a total of 380 mcg (36 mcg/kg) had been given, and was stopped when the error was discovered. A peripheral blood sugar level was found to be 26 mg/dL. The significant hypoglycemia likely was due to substrate deficiency, with a possible dexmedetomidine effect.

The pediatric cardiac patient presenting for noncardiac surgery

PURPOSE OF REVIEW

To summarize results of recent papers and discuss current trends concerning anesthesia in children with congenital heart disease presenting for noncardiac surgery.

RECENT FINDINGS

Children with congenital heart disease have a significant incremental risk when presenting for minor or major surgery. It is a current trend that noncardiac surgery should be performed in pediatric centers, which have anesthesiologists and pediatricians familiar with the multiple specialties of children with congenital heart disease. A careful preoperative evaluation using a multidisciplinary approach is of great importance. In recent studies and case reports, the safe use of newer anesthetic agents, such as sevoflurane or desflurane, was reported in combination with opioids or regional blocks. In addition to standard monitors, invasive monitoring should be considered liberally perioperatively in patients with limited hemodynamic reserve and with major surgery. Several case reports reported that laparoscopic surgery was successfully performed even in high-risk patients with congenital heart disease.

SUMMARY

Careful preoperative evaluation, experienced anesthesiologists, suitable anesthetic agents and techniques, and the liberal use of invasive monitoring are integral parts of safe and effective anesthetic care in children with congenital heart disease. Future studies have to show whether laparoscopic surgery may be beneficial in this special subgroup of patients.

Experience with remifentanil in neonates and infants

Remifentanil is a relatively new synthetic opioid, which is not licensed worldwide for neonates and infants. Because of its unique pharmacokinetic properties with a short recovery profile, it could be the ideal opioid for neonates and infants, who are especially sensitive to respiratory depression by opioids. Therefore, we conducted a MEDLINE search on all articles dealing with the use of remifentanil in this important subgroup of patients. Most experience with remifentanil in neonates and infants is as maintenance anaesthesia during surgery. In approximately 300 neonates and infants, remifentanil proved to be an effective and safely used opioid for this indication. However, very limited data exist on remifentanil for analgesia and sedation of mechanically ventilated paediatric intensive care patients. Further research with remifentanil in neonates and infants should focus on this group of patients because remifentanil, with its very short context-sensitive half-life, could result in shorter extubation times compared with commonly used opioids such as morphine or fentanyl.