Total intravenous anaesthesia with propofol and remifentanil in paediatric patients: a comparison with a desflurane-nitrous oxide inhalation anaesthesia

Background: Remifentanil is a new rapid-acting and ultra-short-acting mu-opioid receptor agonist with few reports from use in children. Therefore, we compared a propofol-remifentanil-anaesthesia (TIVA) with a desflurane-N2O-anaesthesia (DN) with particular regard to the recovery characteristics in children. Methods: 50 children (4-11 yr) scheduled for ENT surgery were randomly assigned to receive TIVA (n=25) or DN (n=25). After standardised i.v. induction of anaesthesia in both groups with remifentanil, propofol and cisatracurium, TIVA was maintained with infusions of propofol and remifentanil. Ventilation was with oxygen in air. DN was maintained with desflurane in 50% N2O. The administration of volatile and intravenous anaesthetics was adjusted to maintain a surgical plane of anaesthesia. At the end of surgery all anaesthetics were terminated without tapering and early emergence and recovery were assessed. In addition, side effects were noted. Results: Both anaesthesia methods resulted in stable haemodynamics but significantly higher heart rate with desflurane. Recovery did not differ between the groups except for delayed spontaneous respiration after TIVA. Spontaneous ventilation occurred after 11+/-3.7 min versus 7.2+/-2.8 min (mean+/-SD, TIVA versus DN), extubation after 11+/-3.7 min versus 9.4+/-2.9 min, eye opening after 11+/-3.9 min versus 14+/-7.6 min and Aldrete score greater than or equal to 9 after 17+/-6.8 min versus 17+/-7.5 min. Postoperatively, there was a significant higher incidence of agitation in the DN-group (80% vs. 44%) but a low incidence (<10%) of nausea and vomiting in both groups. Conclusion: In children, TIVA with remifentanil and propofol is a well-tolerated anaesthesia method, with a lower peroperative heart rate and less postoperative agitation compared with a desflurane-N2O based anaesthesia.