Application Of Sevoflurane Combined With Remifentanil Anesthesia For Children Tonsillectomy

Objective To evaluate the effect and feasibility of sevoflurane inhalation anesthesia combined with remifentanil intravenous anesthesia inchildren undergoing tonsillectomy. Methods Forty patients(aged 6-12 yr), ASA statusâ… -â…¡, undergoing tonsillectomy were randomly divided into two groups:the sevoflurane group(S group, n=20)and the propofol group(P group, n=20).In the S group, anesthesia induction was with 8% sevoflurane before remifentanil 2μg/kg, rocuronium 0.6mg/kg and Dexamethasone 0.1 mg/kg infusion, whereas in the P group propofol 2.5 mg/kg,remifentanil 2μg/kg, rocuronium 0.6mg/kg and Dexamethasone 0.1 mg/kgwas administered. After tracheal intubation, the patients received 2～3% sevoflurane with remifentanil 0.25μg/kg. min or propofol 7～9 mg/kg.h with remifentanil 0.25μg/kg. min for anesthesia maintenance. During anesthesia induction and maintenance, the range of BIS was from 45 to 55, MAP was from 60mmHg to 90mmHg, HR was from 80 to 120and P_ETCO₂ wasfrom 35mmHg to 45mmHg. At the same time, Extinction time of lash reflex and status of cough, vomit, larynx spasm, escape, extremity movement, secretion and glottis exposure were observed. The variations of MAP, HR and SpO₂ were recorded at eight time points:five minutes before anesthesia induction(T1),the moment just before intubation(T2),the moment just after intubation(T3),one minute after intubation(T4),three minutes after intubation(T5),five minutes after intubation(T6),the moment when resecting the tonsil(T7) and the moment just after the operation(T8).The levels of ACTH and ANP were also recorded at T1, T2, T6, T7 andT8. After the operation, we evaluated all kinds Of parameters of postoperative recovery. Results During the tracheal intubation, there was more secretions in the R group than in the P group(P＜0.05).Most of patients in the R group felt painful obviously when propofol was administered(P＜0.05).In the R group and P group, the blood pressure at T2, T3, T4, T5 and T6 was lower than at T1 (P＜0.05),the HR at T2 was less thanat T1(P＜0.05),the levels of ACTH at T2, T6, T7, T8 and T1 were similar(P＞0.05) and the ANP at T2 and T1 had statistical differences(P＜0.05).There were no statistical differences in MAP, HR, ACTH and ANP between the R group and P group(P＞0.05). The time of postoperative recovery ofthe S group was shorter than the P group (P＜0.05) and postoperative secretions was less than the P group (P＜0.05).Conclusions 1. anesthesia induction by sevoflurane combined with remifentanil is convenient, painless and does not augment secretion. It is easy to be accepted by children. 2. sevoflurane-remifentanil anesthesia is convenient in the respiratory tract administration after tonsillectomy.