The best method was the combination of remifentanil 4 microg kg(-1) and propofol 2.5 mg kg(-1). This provided satisfactory intubating conditions in 93%, and prevented cardiovascular intubation response.

In a double-blind, randomized study, we have compared the efficacy of transdermal hyoscine in the prevention of nausea and vomiting with placebo in 60 young, ASA I-II patients after middle ear surgery during general anaesthesia. In the placebo group, 27% and 43% of patients suffered from nausea and vomiting, respectively, during the first 24 h after anaesthesia. The corresponding values for both symptoms in the hyoscine group were 10% (P < 0.001 between groups). The frequency of side effects was similar in both groups. The results suggest that transdermal hyoscine is a useful prophylaxis against nausea and vomiting after middle ear surgery.

Purpose: To compare the intubating conditions after remifentanil-propofol with those after propofol-rocuronium combination with the aim of determining the optimal dose of remifentanil.Methods: In a randomized, double-blind study 80 healthy children aged three to nine years were assigned to one of four groups (n=20): 2 or 4 µg·kg -1 remifentanil (Re2 or Re4); 2 µg·kg -1 remifentanil and 0.2 mg·kg -1 rocuronium (Re2-Ro0.2); 0.4 mg·kg -1 rocuronium (Ro0.4). After atropine, remifentanil was injected over 30 sec followed by 3.5 mg·kg -1 propofol and rocuronium. After 60 sec, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor based on ease of ventilation, jaw relaxation, position of the vocal cords, and coughing to intubation.Results: In all children intubation was successful. Overall intubating conditions were better (P < 0.01), and the frequency of excellent conditions, 85%, was higher (P < 0.01) in the Re4 group than in the Ro0.4 group. No child manifested signs of muscular rigidity. In the remifentanil groups, arterial pressure decreased 11-13% and heart rate 6-9% after anesthetic induction, and remained at that level throughout the study. Conclusion:The best intubating conditions were produced by the combination of 4 µg·kg -1 remifentanil and 3.5 mg·kg -1 propofol. It provided excellent or good intubating conditions in all children without causing undue cardiovascular depression.Objectif : Comparer les conditions d'intubation après l'usage d'une combinaison de rémifentanil-propofol avec celles d'une combinaison de propofol-rocuronium dans le but de déterminer la dose optimale de rémifentanil.Méthode : Lors d'une étude randomisée et à double insu, 80 enfants en bonne santé, de trois à neuf ans, ont été répartis en quatre groupes (n=20) et ont reçu : 2 ou 4 µg·kg -1 de rémifentanil (Ré2 ou Ré4); 2 µg·kg -1 de rémifentanil et 0,2 mg·kg -1 de rocuronium (Ré2-Ro0,2); 0,4 mg·kg -1 de rocuronium. Après l'administration d'atropine, le rémifentanil a été injecté pendant 30 s et a été suivi de 3,5 mg·kg -1 de propofol et de rocuronium. La laryngoscopie et l'intubation ont été tentées après 60 s. Les conditions d'intubation ont été évaluées comme excellentes, bonnes ou pauvres selon la facilité de la ventilation, la relaxation de la mâchoire, la position des cordes vocales et la toux pendant l'intubation.Résultats : L'intubation a été réussie chez tous les enfants. Les conditions générales d'intubation ont été meilleures (P < 0,01), et la fréquence d'excellentes conditions, 85 %, plus élevée (P < 0,01) dans le groupe Ré4 que dans le groupe Ro0,4. Aucun enfant n'a manifesté de signe de rigidité musculaire. Dans les groupes rémifen-tanil, la tension artérielle a baissé de 11-13 % et la fréquence cardiaque de 6-9 % après l'induction de l'anesthésie et sont demeurées à ce niveau tout au long de l'étude. Conclusion :Les meilleures conditions d'intubation ont été réalisées avec la combinaison de 4 µg·kg -1 de rémifentanil et de 3,5 mg·kg -1 de propofol. L'intubation a été bo...

In a double-blind study, propofol (P) 2-2.5 mg.kg-1 preceded by saline (Sal) or alfentanil (A) 20-30 micrograms.kg-1 was used for anaesthetic induction in 59 young patients of ASA physical class I or II, premedicated with oxycodone 0.1 mg.kg-1 and atropine 0.01 mg.kg-1 i.m. The patients were randomly allocated to one of the four groups: Group 1 Sal + P2.5, Group 2 A20 + P2.5, Group 3 A30 + P2.5 and Group 4 A30 + P2. Pain on injection of propofol occurred in 67, 36 and 7% of the patients in the Sal + P2.5, A20 + P2.5 and A30 + P2 groups, respectively, but not at all in the A30 + P2.5 group. Intubating conditions were assessed as good, moderate, poor or impossible on the basis of jaw relaxation, ease of insertion of the tube and coughing on intubation, each on a three-point scale. In impossible cases, suxamethonium was used. In the Sal + P2.5 group, the frequencies of good, moderate, poor and impossible intubating conditions were 0, 38, 8 and 54%, respectively. The corresponding figures in the A30 + P2.5 group were 43, 46, 7 and 14% (P less than 0.05 between the groups). The other groups did not differ significantly from the Sal + P2.5 group. After injection of propofol, both systolic and diastolic arterial pressures decreased significantly in all other groups, with the exception of diastolic pressure in the Sal + P2.5 group, whereas heart rate did not differ from the control level. After intubation, systolic arterial pressure increased statistically significantly in the Sal + P2.5 and A30 + P2 groups and diastolic arterial pressure in all other groups with the exception of the A30 + P2.5 group when compared with the corresponding preceding values.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of propofol 2 mg/kg, methohexital 2 mg/kg or midazolam 0.3 mg/kg were studied on the QT interval of the ECG corrected by the heart rate (QTc), heart rate and arterial pressure during induction of anaesthesia in 87 ASA class I-(II)-patients. The patients were randomly allocated to one of the three anaesthetic groups. The incidence of the patients with a prolonged QTc interval (= more than 440 ms) ranged from 29 to 41% between the groups. In each group these patients were treated separately. After all anaesthetics, the QTc interval was significantly prolonged in the patients with a normal control QTc interval, whereas in the patients with a prolonged control QTc interval, it tended to be shortened both after propofol and methohexital and it was significantly shortened after midazolam. After injection of suxamethonium, no significant QTc interval changes occurred in the patients with a normal control QTc interval in either the propofol or the methohexital groups, whereas in the patients with a prolonged control QTc interval treated with propofol the QTc interval decreased significantly 60 s after suxamethonium when compared with the corresponding preceding values. The mean values in the propofol group in the patients with a normal control QTc interval were always below the upper limit of the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)

Chloral hydrate 25, 50 or 75 mg kg-1 or midazolam 0.4, 0.5 or 0.6 mg kg-1, all given by mouth in combination with atropine 0.03 mg kg-1, were compared as premedication in 248 children in a randomized, double-blind study. Chloral hydrate was significantly less palatable than midazolam. The anxiolytic effect of chloral hydrate 75 mg kg-1 was "good" in children younger than 5 yr, whereas the other doses of chloral hydrate, and all doses of midazolam, provided only "fair" anxiolysis in this age group. All doses of both premedicants provided good anxiolysis in the older children. A satisfactory antisialogogue effect was seen in 83-90% of each group. About 20 min after extubation, restlessness was observed in 15-25% of the younger children premedicated with chloral hydrate 25 mg kg-1 or with midazolam 0.4 or 0.6 mg kg-1. The mean total recovery score (0-10) based on activity, ventilation, heart rate, conscious level and colour ranged between 5.8 and 6.8 at 10 min and between 9 and 9.5 at 70 min after extubation in all groups. Midazolam 0.5 mg kg-1 is recommended for children less than 5 yr of age and midazolam 0.4-0.5 mg kg-1 for older ones. Chloral hydrate 75 mg kg-1 provided good anxiolysis in both age groups; however, it was less palatable than the midazolam.

The haemodynamic response to endotracheal intubation and changes in the QT interval of ECG during anaesthetic induction were studied in 68 healthy children (5.5 years). The children were pretreated double-blindly with either alfentanil 10 micrograms/kg (A10), 25 micrograms/kg (A25), 50 micrograms/kg (A50) or saline (control) (17 children in each group) i.v. 1 min before thiopentone 5 mg/kg. The trachea was intubated after suxamethonium 1.5 mg/kg. Central nervous system excitation was seen in four of 17 and in one of 17 children after alfentanil 50 and 25 micrograms/kg, respectively. After intubation, heart rate increased significantly in the control group, remained at initial levels in the A10 and A25 groups and decreased in the A50 group. A pressor response to intubation was seen in the control and A10 groups. The QT interval was significantly prolonged after suxamethonium in the control and A10 groups, but remained at baseline levels in the A25 and A50 groups. Ventricular ectopic beats were only seen in 2/17 children in the control group. In conclusion, alfentanil 25 microgram/kg is ideal for preventing the haemodynamic response to endotracheal intubation and prolongation of the QT interval, a sign of sympathoadrenal activation, before induction of intravenous anaesthesia in children.

In a double-blind study, intubating conditions and haemodynamic responses were assessed in two age-groups of 45 ASA I-II children, with mean ages of 2.4 and 6.3 years, premedicated with oral midazolam and atropine. The children were randomly allocated to one of three groups: alfentanil 20 micrograms.kg-1 + lidocaine 1 mg.kg-1 (Alf20 + Lign); alfentanil 20 micrograms.kg-1 (Alf20); or alfentanil 40 micrograms.kg-1 (Alf40), followed by propofol 3.5 mg.kg-1 in the children aged 1-3 years and 3.0 mg.kg-1 in the older children. Intubating conditions, 40 s after the administration of propofol, were assessed as good, moderate or impossible on the basis of jaw relaxation, ease of insertion of the endotracheal tube and coughing during intubation. In the younger age group the frequencies of good, moderate or impossible intubating conditions were 87, 13 and 0% in the Alf40, 40, 60 and 0% in the Alf20 (P < 0.05 compared to the Alf40 group) and 53, 47 and 0% in the Alf20 + Lign group. In the older age group the corresponding frequencies were 60, 33 and 7% in the Alf20 + Lign, 47, 53 and 0% in the Alf20 and 47, 40 and 13% in the Alf40 group. All the drugs prevented any increase in arterial pressure and heart rate after tracheal intubation. The QTc interval of the ECG was always in the normal range. Clinically important bradycardia did not occur. In conclusion, the best intubating conditions occurred after propofol 3.5 mg.kg-1 and alfentanil 40 micrograms.kg-1 in the younger age group.(ABSTRACT TRUNCATED AT 250 WORDS)