Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2024; 16(7): 2065-2072
Published online Jul 27, 2024. doi: 10.4240/wjgs.v16.i7.2065
Evaluation of the clinical effects of atropine in combination with remifentanil in children undergoing surgery for acute appendicitis
Yu-Juan Li, Yong-Yan Chen, Xia-Lan Lin, Wei-Zhi Zhang
Yu-Juan Li, Yong-Yan Chen, Xia-Lan Lin, Wei-Zhi Zhang, Department of Anesthesiology, Shanxi Provincial Children’s Hospital, Taiyuan 030013, Shanxi Province, China
Author contributions: Li YJ designed the research and wrote the first manuscript; Chen YY and Lin XL contributed to conceiving the research and analyzing data; Zhang WZ conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethic Committee of Shanxi Provincial Children’s Hospital (Approval No. IRB-KYYN-2023-010).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Dr. Zhang has nothing to disclose.
Data sharing statement: All data and materials are available from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Zhi Zhang, MD, Doctor, Department of Anesthesiology, Shanxi Provincial Children’s Hospital, No. 13 Xinmin North Street, Taiyuan 030013, Shanxi Province, China. zwzzwzjack@163.com
Received: February 28, 2024
Revised: May 6, 2024
Accepted: May 7, 2024
Published online: July 27, 2024
Processing time: 145 Days and 1.2 Hours
Abstract
BACKGROUND

Acute appendicitis (AA) is the most common cause of acute abdomen in children. Anesthesia significantly influences the surgical treatment of AA in children, making the scientific and effective selection of anesthetics crucial.

AIM

To assess the clinical effect of atropine (ATR) in combination with remifentanil (REMI) in children undergoing surgery for AA.

METHODS

In total, 108 cases of pediatric AA treated between May 2020 and May 2023 were selected, 58 of which received ATR + REMI [research group (RG)] and 50 who received REMI [control group (CG)]. Comparative analyses were conducted on the time to loss of eyelash reflex, pain resolution time, recovery time from anesthesia, incidence of adverse events (AEs; respiratory depression, hypoxemia, bradycardia, nausea and vomiting, and hypotension), intraoperative responses (head shaking, limb activity, orientation recovery, safe departure time from the operating room), hemodynamic parameters [oxygen saturation (SPO2), mean arterial pressure, heart rate, and respiratory rate], postoperative sedation score (Ramsay score), and pain level [the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale].

RESULTS

Compared with the CG, the RG showed significantly shorter time to loss of eyelash reflex, pain resolution, recovery from anesthesia, and safe departure from the operating room. Furthermore, the incidence rates of overall AEs (head shaking, limb activity, etc.) were lower, and influences on intraoperative hemodynamic parameters and stress response indexes were fewer. The Ramsay score at 30 min after extubation and the FLACC score at 60 min after extubation were significantly lower in the RG than in the CG.

CONCLUSION

ATR + REMI is superior to REMI alone in children undergoing AA surgery, with a lower incidence of AEs, fewer influences on hemodynamics and stress responses, and better post-anesthesia recovery.

Keywords: Atropine; Remifentanil; Pediatric acute appendicitis; Surgery; Clinical efficacy

Core Tip: Pediatric acute appendicitis (AA) is usually treated surgically (appendectomy), and anesthesia has a significant impact intraoperatively. Scientific and effective selection of anesthetics is crucial in preventing postoperative adverse events (AEs) and improving surgical outcomes for pediatric AA. This study compared and analyzed the clinical effects of atropine (ATR) combined with remifentanil (REMI) and REMI monotherapy in children undergoing surgery for AA. ATR combined with REMI exhibited a better anesthetic effect than REMI alone, with a lower incidence of AEs, relatively fewer influences on hemodynamics, milder stress responses, and faster recovery from anesthesia.