Dr Rakesh, congratulation for your presentation, it was an interesting case. As we know, prolonged ventilatory support and recovery from anesthesia must be antecipated and I think to prevent or reduce these complications we have to use short-action opioids such as remifentanil, which is broken by tissue and hepatic esterases enzimes what give it 9-11 min of sensitive-context half-life. Of course, we need to prevent pos-operatory pain using morfine (0,1-0,15mg/Kg) in the intraoperatory course (usually we give that dose 50 min before the end of surgery). Then, the combination of sevoflurane (0,81 MAC) with remifentanil might improve our outcome with reduced need of ventilatory support in ICU.
Anesthesiologyst of Hospital Universitário Oswaldo CRuz - REcife-PE-Brazil