Comparison of The Effectiveness of Remifentanyl versus Fentanyl in Pediatric Undergoing Methotrexate Therapy

Authors

  • Purwoko Purwoko Anesthesiology Department, Moewardi General Hospital, Surakarta, Indonesia
  • Bambang Novianto Putro Anesthesiology Department, Moewardi General Hospital, Surakarta, Indonesia
  • Ferdy Pamungkas Anesthesiology Department, Moewardi General Hospital, Surakarta, Indonesia
  • Febby Gunawan Siswanto Medical Faculty Universitas Sebelas Maret, Moewardi General Hospital, Surakarta, Indonesia

Abstract

Background: Anesthesia procedure is routinely performed for some painful pediatric oncologic procedures such as lumbar puncture (LP) and bone marrow examination (BME).  Several studies mentioned that fentanyl and remifentanyl are often used as anesthetic agent of this procedure, but none of them compare the recovery time of both agent. This study aims to compare the recovery time of fentanyl and remifentanyl in pediatric patients undergoing methoterexate therapy.

Subjects and Method: This was a double-blind randomized controlled trial on 36 patients who underwent intratechal methotrexate chemoterapy under general anesthesia anesthesia in pediatric intervention room of Moewardi General Hospital Surakarta that met inclusion criteria. The dependent variable was recovery time and the independent variable were fentanyl and remifentanyl. The samples were divided into 2, Fentanyl (F) and Remifentanyl (R) group. Recovery time was recorded after the procedure until the subject reached Pediatric Glasgow Comma Scale (PGCS) of 15. Statistical analysis was Mann Whitney U Test using SPSS 25 for Windows.

Results: The mean recovery time of F group was 373.39 ± 29.48 seconds, while R group was 124.67±11.55 seconds. There was a significant difference in recovery time between patients in the Fentanyl group and the Remifentanyl group (p= 0.000).

Conclusion: Remifentanyl recovery time was significantly faster than with fentanyl in pediatric patients undergoing intrathecal methotrexate chemotherapy.

Keywords: Fentanyl, Methotrexate, Outpatient anesthesia, Recovery time, Remifentanyl

Correspondence: Ferdy Pamungkas. Anesthesiology Department, Moewardi General Hospital, Surakarta. Jalan Kolonel Sutarto 132 Jebres, Kecamatan Jebres, Surakarta City 57126. Central Java, Indonesia. dr.ferdypamungkas@gmail.com. +6281230269501.

Indonesian Journal of Medicine (2022), 07(01): 115-121
https://doi.org/10.26911/theijmed.2022.07.01.12

Author Biographies

Purwoko Purwoko, Anesthesiology Department, Moewardi General Hospital, Surakarta, Indonesia

Anesthesiology and Intensive Therapy

Bambang Novianto Putro, Anesthesiology Department, Moewardi General Hospital, Surakarta, Indonesia

Anesthesiology and Intensive Therapy

Ferdy Pamungkas, Anesthesiology Department, Moewardi General Hospital, Surakarta, Indonesia

Anesthesiology and Intensive Therapy

References

Bajwa JS, Sharma V, Sharma R (2017). Anesthesia for Day-Care Surgeries: Current Perspectives. Med J DY Patil Vidyapeeth. 10(4): 327–333. doi: 10.4103/MJDRDYPU.MJDRDYPU_24_17

Butterwoth JF, Mackey DC, Wasnick JD (2018a). Ambulatory non–operating room anesthesia. In 2Morgan Mikhail’s Clinical Anesthesiology. United States of America: McGraw-Hill Education: 1591–1621.

Butterwoth JF, Mackey DC, Wasnick JD (2018b). Intravenous Anesthetics. In Morgan Mikhail’s Clinical Anes-thesiology. United States of America: McGraw-Hill Education: 304–329.

Chayapathi V, Kalra M, Bakshi AS, Mahajan A (2018). A comparison of ketamine + midazolam to propofol for proce-dural sedation for lumbar puncture in pediatric oncology by nonanesthesio-logists-a randomized comparative trial. Pediatr Blood Cancer. 2018 65(8): e27108. doi: 10.1002/pbc.27108.

Chollat C, Maroni A, Aubelle MS (2019). Efficacy and safety aspects of remifen-tanil sedation for intubation in neo-nates: A retrospective study. Front Pe-diatr. 7: 450. DOI: 10.3389/fped.-2019.00450.

Duffy EA, Adams T, Thornton CP (2019). Evidence-based recommendations for the appropriate level of sedation to manage pain in pediatric oncology patients requiring procedures: A systematic review from the children’s oncology group. J Pediatr Oncol Nurs. 37(1): 6–20. DOI: 1043454219858610.

Gorji, FB, Amri P, Shokri J, Alereza H, Bijani A (2016). Sedative and analgesic effects of propofol-fentanyl versus propofol-ketamine during endoscopic retrograde cholangiopancreatography: A double-blind randomized clinical trial. ISRAPM. 6(5). DOI: 10.5812/aa-pm.39835.

Gulec H (2015). Ketamine-propofol sedation in circumcision. Rev Bras Anestesiol. 65(6). DOI: 10.1016/j.bjane.2014.03.-002.

Nazemroaya B, Majedi MA, Shetabi H, Salmani S (2018). Comparison of pro-pofol and ketamine combination (keto-fol) and propofol and fentanyl combi-nation (fenofol) on quality of sedation and analgesia in the lumpectomy: A Randomized Clinical Trial. Adv Biomed Res. 7(134). DOI: 10.4103/abr.-abr_85_18.

Omara AF, Abdelrahman AF, Elshiekh ML (2019). Recovery with Propofol Anes-thesia in Children Undergoing Cleft Palate Repair Compared with Sevo-flurane Anesthes. ISRAPM. 9(3). DOI: 10.5812/aapm.92076.

Soontrakom T, Kamata M, Kuratani N (2018). Use of remifentanil in general anesthesia for neonatal non-cardiac surgery: A case series. JA Clin Rep. 4(8). DOI: 10.1186/s40981-018-0218-6.

Sung TY, Lee DK, Bang J, Choi J, Shin S, Kim TY (2020). Remifentanil-based propofol-supplemented vs. balanced sevoflurane-sufentanil anesthesia regi-mens on bispectral index recovery after cardiac surgery: A randomized controlled study. Anesth Pain Med. 15(4): 424–433. DOI: 10.17085/apm.-20022.

Vittinghoff M, Lönnqvist PA, Mossetti V, Heschl S, Simic D, Colovic V, Dmy-triiev D, et al. (2018). Postoperative Pain Management in Children: Gui-dance from the Pain Committee of the European Society for Paediatric Anaes-thesiology (ESPA Pain Management Ladder Initiative). Pediatr Anesth. 28(6): 493–506. DOI: 10.1111/pan.-13373.

Wang K, Xin J, Wang X, Yu H, Liu X (2019). Pregnancy outcomes among 31 patients with tetralogy of fallot, a retrospective study. BMC Pregnancy Childbirth. 19: 486. DOI: 10.1186/-s12884-019-2630-y.

Wang W, Huang P, Gao W, Cao F, Yi M, Chen L, Guo X (2016). Efficacy and acceptability of different auxiliary drugs in pediatric sevoflurane anes-thesia: A network meta-analysis of mixed treatment comparisons. Sci Rep. 6: 36553. DOI: 10.1038/srep3-6553.

Downloads

Published

2022-01-10

Issue

Section

Articles