Remifentanil versus fentanyl for esophagogastroduodenoscopy in children.

Objectives: We compared sedation by propofol combined with either fentanyl or remifentanil in pediatric outpatients undergoing diagnostic esophagogastroduodenoscopy. Patients and Methods: Forty-two children scheduled for esophagogastroduodenoscopy in our institution were randomly assigned to receive 2 mg/kg propofol plus either 1 μg/kg bolus of fentanyl (group F; n = 20) or 0.5 μg/kg bolus of remifentanil (group R; n=22). Cardiorespiratory parameters, sedation level, adverse effects related to the drugs and/or to the procedure, ease of performance for the endoscopist, and time to awakening were analyzed. Results: There were no clinically significant changes in hemodynamics. Apnea periods >20 seconds and decreases in SaO 2 0.05, respectively). Children in group R had significantly shorter average time to awakening: 9.5±5.6 vs 16.5±10.5minutes (P=0.01 and received a significantly lower total dose of propofol (P=0.034). Adverse effects within the first 24 hours postprocedure occurred less frequently in group R (P=0.03). Conclusions: Remifentanil in combination with propofol provides good analgesic and sedative effects, which were shorter lasting compared with fentanyl-based sedation, and caused fewer delayed adverse effects. The use of remifentanil was associated with respiratory depression, emphasizing the need for experienced anesthesiologists.