The combined effect of ketamine and remifentanil infusions as total intravenous anesthesia for scoliosis surgery in children.

Background: This study was designed to assess the effect of combination of ketamine and remifentanil infusions as total intravenous anesthesia (TIVA) during scoliosis surgery in children.

Methods: Thirty two children, 8-14 yr of age, scheduled for posterior spinal fusion, were randomly allocated into two equal groups to receive either remifentanil infusion in a dose of 0.2 microg/kg/minutes or same dose of remifentanil infusion combined with ketamine infusion in a dose of 1 microg/kg/minutes after induction of general anesthesia. During surgery, hemodynamics, surgical bleeding, and electrophysiology monitors were recorded. After completion of surgery, recovery score, recovery time and rescue analgesia were assessed in post-anesthesia care unit (PACU) for 24 hours.

Results: The two groups were similar for age, weight, duration of surgery, and time to extubation. Intraoperative heart rate and arterial blood pressure were significantly decreased in remifentanil group when compated to remifentanil-ketamine group. The surgical bleeding and electrophysiological monitoring were not significantly affected by remifentanil-ketamine combination in second group. Recovery score and recovery time were not significantly increased in remifentanil-ketamine group. First pain scores recordings in arrival to (PACU) were significantly less in remifentanil-ketamine group than remifentanil group and the time passed to first patient controlled analgesia (PCA) demand dose was increased in remifentanil-ketamine group. The first 24 h morphine consumption was 38 +/- 17 and 28 +/- 10 mg (mean +/- SD) in remifentanil and remifentanil-ketamine groups, respectively.

Conclusions: These data demonstrate that during posterior spinal fusion surgery in children, the combination of ketamine and remifentanil infusions as TIVA may provide hemodynamic stability, satisfactory surgical requirements with reliable electrophysiological monitoring and adequate post operative pain relief supplemented by PCA morphine.