Remifentanil Dose Modulation for Alleviating Tourniquet Reactions in Cerebral Palsy Patients Undergoing Orthopedic Surgery.

PURPOSE: To evaluate the efficacy of remifentanil in maintaining hemodynamic stability along with postoperative recovery in cerebral palsy (CP) children following tourniquet use during orthopedic surgery (OS). DESIGN: A retrospective cohort study. METHODS: In this retrospective cohort study, we included CP children received remifentanil infusion at 40 minutes after tourniquet application before OS surgery. In the adjustment group, remifentanil dose increased to 0.5 µg/kg/min at 40 post-tourniquet application, and then gradually reduced to 0.25 µg/kg/min at 60 minutes. The control group maintained a constant dose of 0.25 µg/kg/min over the same period. Then we compared the blood pressure (BP), heart rate (HR), intraoperative blood loss, recovery after anesthesia, inpatients' length-of-stay (LOS), mobilization out of bed after OS, incidence of adverse events (AEs), and sedation and pain scores between the groups. FINDINGS: The adjustment group showed significantly lower BP and HR during surgery. Additionally, they experienced shorter anesthesia recovery time, LOS, and earlier mobilization. Sedation and pain scores, as well as the incidence of AEs, were also significantly lower in adjustment group compared to controls. CONCLUSIONS: Dose modulation of remifentanil infusion in children reduced BP and HR, and shorten recovery time after anesthesia, LOS, and time to mobilization out of bed after OS, with less AEs.