Propofol–alfentanil Vs Propofol–fentanyl For Sedation And Analgesia In Pediatric Patients Undergoing Burn Dressing Changes: A Randomized Controlled Trial

Objective:To compare the sedative and analgesic effects between the alfentanil-propofol and fentanyl-propofol in pediatric burn patients undergoing dressing changes,and to provide evidence-based optimization of anesthesia drug compatibility for pediatric burn dressing changes.Methods:A total of 60 children（≤2 dressing changes during this hospitalization）undergoing scheduled burn dressing changes were recruited,with ages ranging from 6 to36 months,BMI≤18 kg/m2,and no gender restrictions.They were randomly divided into the AP group（alfentanil-propofol）and the FP group（fentanyl-propofol）,with 30 children in each group.Routine fasting was conducted before surgery,and the anesthesia drug regimen during surgery was alfentanil 10μg/kg+propofol 2.5 mg/kg for the AP group,and fentanyl 2μg/kg+propofol 2.5 mg/kg for the FP group.If there was any movement that interfered with the dressing change operation by the surgeon,propofol 1 mg/kg was added once.The general information of the children during the dressing change,pain scores,incidence of adverse events,time to leave the operating room,hemodynamic variables,number of additional drugs,transcutaneous end-tidal CO₂,NT value,and surgeon satisfaction scores were recorded.Results:This was a prospective,double-blind,randomized controlled trial,with a total of60 children recruited.Exclusion criteria included severe illness,liver and kidney damage,and lack of written informed consent by parents or guardians,resulting in a final sample size of 52（26 in the AP group and 26 in the FP group）.There was no statistically significant difference between the AP and FP groups in terms of age,gender,or percentage of burn area.The weight of the FP group was slightly higher than that of the AP group（P=0.023）,but there were no overweight or obese children,which did not affect the results of this study.The wake up-time in the AP group was shorter than that in the FP group（10.0（5.0,20.0）min vs.15.0（10.0,26.3）;P<0.001）.During the entire operation,2 cases of respiratory depression occurred in the AP group,with 1 child self-relieved without intervention after 1 minute,and the other child relieved after breathing assistance.The incidence of adverse events was 7.7%.In the FP group,there were a total of 4 adverse events,with 3 cases of respiratory depression,1 of which developed into hypoxemia,and the other 2 self-improved without intervention.There was also 1 case of airway spasm,which improved after administration of methylprednisolone sodium succinate.The incidence of adverse events was 15.4%,and the difference in the incidence of adverse events between the two groups was statistically significant（P<0.05）.The satisfaction of the operation physician in the AP group was higher than that in the FP group,with a statistically significant difference（P<0.05）.There were no significant differences observed between the two groups in terms of the number of additional drugs,pain scores before and after dressing changes,sedation depth（NT value）,or the incidence of CO₂accumulation.Conclusion:Both alfentanil-propofol and fentanyl-propofol are safe and effective for sedation and analgesia in pediatric burn patients undergoing dressing changes.However,the alfentanil-propofol regimen exhibited a faster wake-up time and a lower incidence of adverse events compared to fentanyl-propofol,providing better applicability for dressing changes in children with burns.