Time to extubation in infants undergoing pyloromyotomy -- isoflurane inhalation vs remifentanil infusion.

Background: Infantile hypertrophic pyloric stenosis (IHPS) associated with metabolic alkalosis, could induce late anesthesia recovery, especially when opioids are used. The aim of this study was to compare the time of extubation and the quality of perioperative analgesia in infants scheduled for pyloromyotomy, receiving either isoflurane inhalation or remifentanil infusion.

Methods: Thirty full-term infants scheduled for pyloromyotomy were prospectively studied. A standardized anesthetic induction was performed. For maintenance of anesthesia, infants were randomly allocated to receive either isoflurane 0.75% of inspired concentration (GI n = 15), or remifentanil as a continuous infusion of 0.4 microg x kg(-1) x mn(-1) (GR n = 15). At the beginning of skin closure, the anesthetic was discontinued and 15 mg x kg(-1) of paracetamol administered. Non parametric tests were used in statistical analysis.

Results: The time to extubation was similar in both groups. The intraoperative heart rate was significantly lower in the GR group.

Conclusion: Remifentanil provided better intraoperative analgesia than isoflurane in infants undergoing pyloromyotomy without increasing time to extubation.