11 JQ1 Debate Guidelines
Roulleau et?al. (47) compared isoflurane associated with either remifentanil or sufentanil and found surprisingly that postoperative pain scores were even lower in the remifentanil group compared with sufentanil. Concerns about remifentanil causing a need for greater analgesic use in the recovery period require further exploration in children. Remifentanil use with isoflurane or sevoflurane in craniosynostosis correction demonstrated no difference in hemodynamic parameters. The short recovery time in both techniques allows reliable neurological assessment immediately after surgery (48). A recent retrospective study reports the use of remifentanil/sevoflurane for abdominal surgery in preterm neonates, full-term neonates and infants http://www.selleckchem.com/products/r428.html neonates, whereas remifentanil is increased in older children (49). This is in contrast with Sammartino et?al. (50) who report higher doses of remifentanil in preterm neonates undergoing analgosedation for laser therapy, using only midazolam bolus as the hypnotic drug. Min, Crawford, and Kwak (51�C53) found similar remifentanil dose requirements for oral tracheal intubation (OTI) or laryngeal mask airway (LMA?) insertion using sevoflurane/propofol bolus (Table?3), while He et?al. (54) showed an inverse relationship between remifentanil and end-tidal sevoflurane (Etsevo) concentration for OTI in children 3�C8?years. Remifentanil is a useful opioid http://www.selleck.cn/products/ABT-263.html when used with propofol for TIVA. Salient benefits include rapid recovery, reduced nausea, vomiting, and postoperative delirium. Furthermore, it has become the technique of choice in particular situations such as in patients with the risk of http://www.selleckchem.com/products/jq1.html malignant hyperthermia. Remifentanil/propofol has been found safe with rapid recovery and uneventful postoperative course in three children affected by Duchenne��s muscular dystrophy undergoing spinal surgery (55). A study by Munoz et?al. (56) demonstrated that as for sevoflurane anesthesia, during propofol anesthesia (57), children 3�C11?years require a remifentanil infusion rate almost twofold higher than adults (0.149 vs 0.080?mcg��kg?1��min?1) to block the somatic response to skin incision. These data are consistent with the increased clearance (expressed as per kilogram) described in children. TCI using propofol with Kataria��s PK model and remifentanil with Minto��s model improves insertion of supraglottic devices suppressing airway reflexes (58). In fact, Park et?al. (59) found that the addition of remifentanil 7.5?ng��ml?1 halved the propofol EC50 (from 5 to 2.5?mcg��ml?1) and improved insertion of laryngeal tube and laryngeal mask in 98 children 2�C12?years.