Low-dose sufentanil as a supplement to halothane/N2O anaesthesia in infants and children

Abstract

Sufentanil as a supplement to halothane/N2O anaesthesia was evaluated in 32 unpremedicated infants and children age 6 months to 9 yr undergoing elective orthopaedic surgery. Patients were randomly assigned in a double-blind manner to receive one of four intravenous supplements: placebo, sufentanil 0.5, 1.0 or 1.5 μg · kg-1. Systolic arterial pressure (SAP), heart rate (HR) and end-tidal halothane concentration were recorded before and after induction, supplement administration, tracheal intubation, incision and every 15 min during the procedure. Venous catecholamine samples were obtained before and after incision. A pain score was assigned to the patients in the postanaesthesia care unit (PACU). Sufentanil at all three doses prevented increases in SAP and HR with intubation and incision, provided superior pain relief in the PACU and did not prolong wake-up time. Sufentanil 1.0 and 1.5 μg · kg-1 allowed far a reduction in the halothane requirements. Sufentanil 1.5 μg · kg1 was associated with lower catecholamine levels than in the placebo group following incision. Sufentanil supplementation at 1.0 and 1.5 μg · kg1 was associated with bradycardia and/or hypotension during induction and an increased incidence of vomiting during the first 24 hours postoperatively. One patient in the sufentanil 1.0 μg · kg-1 group whose surgical time was less than 45 min exhibited respiratory depression in the PACU requiring narcotic reversal. In conclusion, sufentanil 0.5 μg · kg1 improved immediate postoperative pain relief and is acceptable as a supplement during halothane anaesthesia in infants and children. The associated side effects of larger doses of sufentanil (1.0 and 1.5 μg · kg1) make their use as a supplement to halothane anaesthesia unacceptable. © 1988 Canadian Anesthesiologists.