A comparison of the outcomes of dexmedetomidine and remifentanil with sufentanil-based general anesthesia in pediatric patients for the transthoracic device closure of ventricular septal defects

Evaluation of the clinical effects of atropine in combination with remifentanil in children undergoing surgery for acute appendicitis

BACKGROUND

Acute appendicitis (AA) is the most common cause of acute abdomen in children. Anesthesia significantly influences the surgical treatment of AA in children, making the scientific and effective selection of anesthetics crucial.

AIM

To assess the clinical effect of atropine (ATR) in combination with remifentanil (REMI) in children undergoing surgery for AA.

METHODS

In total, 108 cases of pediatric AA treated between May 2020 and May 2023 were selected, 58 of which received ATR + REMI [research group (RG)] and 50 who received REMI [control group (CG)]. Comparative analyses were conducted on the time to loss of eyelash reflex, pain resolution time, recovery time from anesthesia, incidence of adverse events (AEs; respiratory depression, hypoxemia, bradycardia, nausea and vomiting, and hypotension), intraoperative responses (head shaking, limb activity, orientation recovery, safe departure time from the operating room), hemodynamic parameters [oxygen saturation (SPO₂), mean arterial pressure, heart rate, and respiratory rate], postoperative sedation score (Ramsay score), and pain level [the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale].

RESULTS

Compared with the CG, the RG showed significantly shorter time to loss of eyelash reflex, pain resolution, recovery from anesthesia, and safe departure from the operating room. Furthermore, the incidence rates of overall AEs (head shaking, limb activity, etc.) were lower, and influences on intraoperative hemodynamic parameters and stress response indexes were fewer. The Ramsay score at 30 min after extubation and the FLACC score at 60 min after extubation were significantly lower in the RG than in the CG.

CONCLUSION

ATR + REMI is superior to REMI alone in children undergoing AA surgery, with a lower incidence of AEs, fewer influences on hemodynamics and stress responses, and better post-anesthesia recovery.

Meta-Analysis on the Anesthetic Effects of Remifentanil plus Dexmedetomidine versus Remifentanil Alone in Cardiac Surgery

In this study, we performed a meta-analysis to investigate the anesthesia effects of remifentanil plus dexmedetomidine versus remifentanil alone in cardiac surgery. Literature search was performed on PubMed, Web of Science, Embase, China Knowledge Infrastructure, Wanfang Data, and other databases for relevant literature published in English or Chinese before October 2021. A total of 17 studies, consisting of 1350 patients, were included in this study. Of these, 10 studies showed that remifentanil plus dexmedetomidine had a good anesthesia effect in cardiac surgery (OR = 3.61, 95% CI: 1.73, 7.52, P < 0.001), and 8 studies showed that the Ramsay score test of anesthesia (SMD = 0.88; 95% CI: -0.77, 2.53; P < 0.001) in the experimental group was better than that in the control group. In addition, changes in the hemodynamic heart rate (SMD = −0.74; 95% CI: -1.41, -0.07; P < 0.001) and mean arterial pressure (SMD = −0.18; 95% CI: -0.72, 0.36; P < 0.001) of the two groups of anesthesia were counted in 17 studies, which also showed that the anesthesia effect of remifentanil plus dexmedetomidine was good. Thus, remifentanil plus dexmedetomidine may be a more promising option for cardiac surgery anesthesia than remifentanil alone.