Effects of different doses of remifentanil combined with sevoflurane anesthesia on postoperative analgesia and hemodynamics in pediatric patients undergoing laparoscopic inguinal hernia repair

Abstract

Background: Laparoscopic inguinal hernia repair (LIHR) has the characteristics of a clear surgical field and short operation time, but it has high requirements for anesthesia. We investigated the impacts of different doses of remifentanil combined with sevoflurane anesthesia on postoperative analgesia and hemodynamics of pediatric LIHR.

Methods: This randomized, double-blind and controlled study included 310 pediatric patients accepting LIHR. Excluding those failed to meet the inclusion or met the exclusion criteria, 280 patients were enrolled and randomized into the control group (sevoflurane) and the low-dose remifentanil & sevoflurane (LRS), medium-dose remifentanil & sevoflurane (MRS) and high-dose remifentanil & sevoflurane (HRS) groups (0.10, 0.20 and 0.25 µg/kg). The Behavior Pain Scale (BPS) (main observation index), Ramsay Sedation Scale (RSS), and Paediatric Anaesthesia Emergence Delirium (PAED) scores were evaluated at 1 h (T4), 3 h (T5), 6 h (T6), 8 h (T7) and 12 h (T8) postoperatively. The dynamic process of BPS, RSS and PAED scores over time was evaluated by analyzing the changes in the area under the curve (AUC) of each score during T4-T8. The changes in mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO₂) before the start of anesthesia (T0), 10-min after the start of surgery (T1), at the time of extubation (T2) and 30-min post-surgery (T3) and postoperative adverse reaction incidence were recorded.

Results: Remifentanil & sevoflurane reduced postoperative BPS and PAED scores and increased RSS score in pediatric patients during T4-T8. The AUC_BPS and AUC_PAED in the LRS, MRS and HRS groups decreased as the remifentanil dose increased, and the AUC_RSS increased as the remifentanil dose rose. During T0-T3, MAP, HR and SpO₂ fluctuated greatly in the control group, but maintained good stability in the LRS, MRS and HRS groups, and the fluctuation in the HRS group was smaller. The HRS group had a lower adverse reaction incidence than the control and LRS groups.

Conclusions: Remifentanil & sevoflurane may have better effects on postoperative pain, sedation and agitation, and may be more conducive to stabilizing hemodynamics. Especially, 0.25 mg/kg remifentanil & sevoflurane have the best anesthetic effect and a low adverse reaction incidence.

Keywords: Behavior pain scale; Hemodynamics; Laparoscopic inguinal hernia repair; Postoperative analgesia; Remifentanil; Sevoflurane.

Fig. 1

Impact of varying dosages of remifentanil in conjunction with sevoflurane anesthesia on postoperative analgesia following pediatric laparoscopy. GraphPad Prism 8.01 software was used to analyze the AUCs of BPS score (A) and RSS score (B) during T4-T8. AUC refers to the total area under the curve of score changing with time. It was obtained by multiplying the score of each time point with the corresponding period and then accumulating the areas of all periods. A decrease in AUC_BPS indicated a better analgesic effect during the postoperative anesthesia awakening period; an increase in AUC_RSS indicated better sedation during the postoperative anesthesia awakening period; one-way ANOVA was used for comparisons among multiple groups; 1-h post operation (T4), 3-h post operation (T5), 6-h post operation (T6), 8-h post operation (T7), 12-h post operation (T8)

Fig. 2

Impact of various dosages of remifentanil together with sevoflurane anesthesia on PAED score of pediatric patients post LIHR. GraphPad Prism 8.01 software was used to analyze the AUC (B) of the PAED score at T4-T8. AUC refers to the total area under the curve of score changing with time. It was obtained by multiplying the score of each time point with the corresponding period, and then accumulating the areas of all periods. A decrease in AUC_PAED indicated a decrease in the incidence of delirium during the postoperative anesthesia awakening period. One-way ANOVA was used for comparisons among multiple groups; 1-h post operation (T4), 3-h post operation (T5), 6-h post operation (T6), 8-h post operation (T7), 12-h post operation (T8)