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

Objectives: Compare between 2 sedoanalgesia 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 72 hours. We compared 2 independent 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 +/- 16 kg. Mechanical ventilation time medium was 22 hours (3-72), wake-up time from withdrawal after removing sedoanalgesia was of 11,8 +/- 10,6 minutes group A and 137,3 +/- 45 minutes group B (P<.001), extubation time after removing sedoanalgesia was of 24 +/- 21 minutes group A and 230 +/- 102 minutes 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. (C) 2020 Published by Elsevier Espana, S.L.U. on behalf of Asociacion Espanola de Pediatria.