Tracheal extubation of deeply anesthetized pediatric patients: a comparison of sevoflurane and sevoflurane in combination with low‐dose remifentanil

Abstract

We aimed to observe the emergence characteristics of children tracheally extubated in deep anesthesia with sevoflurane or sevoflurane in combination with low-dose remifentanil. We randomly allocated 50 pediatric patients undergoing elective electronic cochlear implantation to groups either receiving sevoflurane (Group S, n = 25), or sevoflurane plus low-dose remifentanil (Group SR, n = 25), during extubation from anesthesia. In Group S, subjects were tracheally extubated while breathing 1.3 times the minimal effective concentration of sevoflurane. In Group SR, subjects were tracheally extubated while breathing 1.0 times the minimal effective concentration of sevoflurane with 0.02-0.05 μg · kg(-1) per min remifentanil. Recovery characteristics and airway complications were noted. There was no significant difference in age, weight, sex, and duration of anesthesia. The average remifentanil rate was 0.036 μg · kg(-1) per min, and compared with Group S, patients in Group SR had a lower respiratory rate (17.3 vs 20.2 per minute, P < 0.05) and a higher ETCO(2) (52.3 vs 49.4 mmHg, P < 0.05). Oral airway usage was also less frequent in Group SR (44% vs 16%, P < 0.01). Additionally, the time from extubation to spontaneous eye opening was shorter in Group SR (10.9 min vs 19.6 min, P < 0.01). Finally, six patients in Group S and five patients in Group SR had a pediatric anesthesia emergence delirium score >10. Low-dose remifentanil in combination with sevoflurane provided rapid recovery and was safe for deep tracheal extubation in deep anesthesia in pediatric patients.