[Midazolam/fentanyl vs propofol/remifentanil in immediate postoperative with short-term mechanical ventilation]

José Domingo López Castilla; Norma Sánchez Fernández; María Teresa Charlo Molina; Antonio Vázquez Florido; Maria Angeles Murillo Pozo; Inmaculada Sánchez Ganfornina; Manuel Fernández Elías; Elía Sánchez Valderrábanos

doi:10.1016/j.anpedi.2020.11.028

[Midazolam/fentanyl vs propofol/remifentanil in immediate postoperative with short-term mechanical ventilation]

An Pediatr (Engl Ed). 2021 Jan 25:S1695-4033(20)30516-6. doi: 10.1016/j.anpedi.2020.11.028. Online ahead of print.

[Article in Spanish]

Authors

José Domingo López Castilla¹, Norma Sánchez Fernández², María Teresa Charlo Molina², Antonio Vázquez Florido², Maria Angeles Murillo Pozo², Inmaculada Sánchez Ganfornina², Manuel Fernández Elías², Elía Sánchez Valderrábanos²

Affiliations

¹ Unidad de Gestión Clínica de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla. Electronic address: pepedomi1953@gmail.com.
² Unidad de Gestión Clínica de Cuidados Intensivos Pediátricos, Hospital Universitario Virgen del Rocío, Sevilla, Sevilla.

PMID: 33509732
DOI: 10.1016/j.anpedi.2020.11.028

Abstract

Objectives: Compare between 2sedoanalgesia regimes, the time from withdrawal of the medication until the patient wakes up and until extubation.

Methodology: Observational study on pediatric patients after elective surgery that needed mechanical ventilation for a period maximum to 72hours. We compared 2independent groups of patients: group A: patients collected prospectively who received sedoanalgesia with propofof-remifentanil and group B: patients who received midazolam-fentanyl collected retrospectively by reviewing medical records and database of the unit. The main variables studied were: Age, weight, sex, interventions type, sedoanalgesia scales, drugs dosages, time from withdrawal of medication to awakening and extubation, and adverse effects.

Results: We collected 82 patients, 43 in group A and 39 in group B. Age (arithmetical mean±standard deviation of patients were 49±65 months, weight 17±16kg. Mechanical ventilation time medium was 22hours (3-72), wake-up time from withdrawal after removing sedoanalgesia was of 11,8±10,6minutes group A and 137,3±45minutes group B (P<.001), extubation time after removing sedoanalgesia was of 24±21minutes group A and 230±102minutes group B (P<.001). Adverse effects were found in 10.5% of patients group A (7.9% agitation, 2.6% bradycardia), and 13% of patients group B (respiratrory depression after extubation), P=.572.

Conclusions: Patients treated with propofol-remifentanil have significantly shorter times to wake up, extubation and withdrawal from mechanical ventilation after stopping the medication. In the midazolam-fentanyl group, respiratory depression was more frequent, although the percentage of adverse effects were similar in both groups. Both the combination of propofol-remifentanil and midazolam-fentanyl appear to be effective as a sedative-analgesic regimen for patients undergoing mechanical ventilation after surgery.

Keywords: Fentanilo; Fentanyl; Midazolam; Propofol; Remifentanil; Remifentanilo; Sedoanalgesia.

Publication types

English Abstract