Comparison of Remifentanil-Based Fast-Track and Fentanyl-Based Routine Cardiac Anesthesia for Intraoperative Device Closure of Atrial Septal Defect (ASD) in Pediatric Patients

Abstract

Background The aim of this study was to evaluate the effectiveness and safety of remifentanil-based fast-track anesthesia for intraoperative device closure of atrial septal defects (ASDs). Material/Methods The clinical data of 152 pediatric patients who received intraoperative device closure of ASD in our hospital from January 2015 to December 2017 were retrospectively analyzed. Patients were divided into 2 groups: group F (remifentanil-based fast-track anesthesia group, n=72) and group C (fentanyl-based routine anesthesia group, n=80). The relevant data from 2 groups were collected and analyzed. Results No significant differences were found in the preoperative data or intraoperative hemodynamic index between these 2 groups. Group C was significantly inferior to group F regarding the duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay, and hospitalization expenses (P<0.05). In terms of postoperative complications, no death, third-degree atrioventricular block, occluder detachment, or residual leakage was reported in either group. The incidence of lung infections and bronchospasm was significantly higher in group C than in group F. There were no anesthetic-related complications. Conclusions The application of remifentanil-based fast-track anesthesia for intraoperative device closure of ASD is as effective and safe as fentanyl-based routine anesthesia. Moreover, remifentanil-based fast-track anesthesia has the advantages of shorter duration of mechanical ventilation, shorter length of hospital and ICU stay, fewer postoperative complications, and lower hospitalization expenses, and is therefore worthy of promotion in clinical practice.

Comparison of the Intraoperative Hemodynamic Effects of Remifentanil and Fentanyl in Pediatric Cardiac Surgery Anesthesia

“…Although there is a limited number of publications in the literature on the use of remifentanil and other opioids in pediatric cardiac surgery, there are studies on the use of remifentanil and other opioids in adult cardiac surgery and other surgeries. Huang et al evaluated 152 pediatric patients with atrial septal defect and emphasized that remifentanil-based fasttrack anesthesia was as effective as fentanyl-based routine anesthesia in intraoperative device closure of atrial septal defect operations [8] . They reported that there was no difference between the two groups in terms of intraoperative hemodynamic values [8] .…”

“…The most important characteristic of remifentanil is that it creates a strong analgesic effect by quickly relieving pain without disturbing hemodynamics [8] . However, since it is rapidly inactivated by nonspecific esterases in blood and tissue, it does not accumulate in the body even in long-term and high-dose applications, unlike other opioids [5,9] .…”

Effect of remifentanil-based fast-track anesthesia on postoperative analgesia and sedation in adult patients undergoing transthoracic device closure of ventricular septal defect

“…To meet the needs of early extubation and short ICU stay after transthoracic device closure of VSD, fast-track anesthesia technology was used in our center. The fasttrack anesthesia technique, which means to help patients regain consciousness and spontaneous breathing as soon as possible, and usually tracheal extubation within 6 h after operation [15][16][17][18]. Fast-track cardiac anesthesia technology is not only an anesthetic measure to help patients recover quickly after the operation but also one of the improvement measures to accelerate the anesthesia management in the perioperative period of rehabilitation.…”

Effects of fast‑track anesthesia on miR‑1 and neuropeptides in serum of patients undergoing cardiac surgery

“…injury. Neuropeptide NSE, S100β protein (S100β) and amyloid β-protein (Aβ) are considered as important indicators to reflect the neurological function, they can reflect the neurological function of the body (10). At present, most of the studies on the application of FTA in cardiac surgery have discussed the indicators such as intraoperative vital signs and the influence on prognosis, but there is still no detailed study on how FTA regulates the functions of the body and its potential molecular targets.…”

“…Troponin has a good correlation, which can be used to evaluate the degree of myocardial ischemia reperfusion injury. Neuropeptide NSE, S100β protein (S100β) and amyloid β-protein (Aβ) are considered as important indicators to reflect the neurological function, they can reflect the neurological function of the body ( 10 ).…”