A comparison of remifentanil and fentanyl for fast track paediatric cardiac anaesthesia

BACKGROUND: Fast track anaesthetic protocols for cardiac surgical patients have been developed to facilitate early tracheal extubation. We compared anaesthetics based on either remifentanil or fentanyl for fast track paediatric cardiac anaesthesia. METHODS: Fifty patients with atrial septal defect or simple ventricular septal defect who were deemed suitable for fast track anaesthetic management were randomly assigned to group R (remifentanil) or group F (fentanyl). After sevoflurane induction, patients received either R infusion or F bolus. Following intubation, isoflurane 0.5 MAC was administered to all patients. Blood pressure (BP) and heart rate (HR) were recorded at baseline and pre- and postinduction, intubation, skin incision and sternotomy. Other parameters measured included time to extubation, reintubation rate and requirements for postoperative analgesia, ondansetron, and nitroprusside in the paediatric intensive care unit. RESULTS: BP decreased similarly from baseline in both groups. Decreases in HR over time were significantly greater in group R. Haemodynamic response to incision/sternotomy was low and similar in both groups. There were no significant differences in extubation time, reintubation incidence, postoperative narcotic requirements, postoperative hypertension or postoperative nausea/vomiting. CONCLUSIONS: The remifentanil based anaesthetic was associated with a significantly slower HR than the fentanyl based anaesthetic. The clinical implications of the slower HR during remifentanil anaesthesia could be important and should be investigated.