Sevoflurane-remifentanil vs isoflurane-remifentanil for the surgical correction of craniosynostosis in infants.

BACKGROUND: The aim of the present study was to compare the efficacy of isoflurane-remifentanil and sevoflurane-remifentanil combinations during neurosurgical correction craniosynostosis.

METHODS: Twenty-two infants with craniosynostosis received a slow bolus of remifentanil followed by continuous infusion. The infants were randomly divided into two groups: remifentanil followed by sevoflurane (the 'sevoflurane group'), and remifentanil followed by isoflurane (the 'isoflurane group'). We monitored electrocardiogram (ECG), heart rate (HR), invasive arterial blood pressure (IABP), pulse oximetry saturation (SpO(2)), endtidal CO(2) (P(ECO(2))), inspired fraction of oxygen (FiO(2)) and endtidal volatile agent (PE volatile agent) at 12 time points, from the beginning of surgery (T0) until the cessation of drugs (T11). The volatile agent was stopped prior to skin suture and the remifentanil infusion after skin closure. Subsequently, we evaluated recovery time of spontaneous breathing and spontaneous eye opening and time of extubation at 5, 10, and 15 min after extubation, the Steward Recovery Score (SRS) was assessed. Patients were then transferred to the Pediatric Intensive Care Unit (PICU).

RESULTS: During the surgical procedure the hemodynamic parameters between the two groups did not show statistically significant differences. There were also no significant differences in terms of awakening time or SRS.

CONCLUSIONS: The rapid recovery of the children (confirmed by their high values of SRS) makes it possible to reliably assess the patient's neurological condition immediately after surgery.