A comparison of remifentanil and fentanyl for fast track paediatric cardiac anaesthesia

Friesen, Robert H.; Veit, Andrew S.; Archibald, David; Campanini, Rafael S.

doi:10.1046/j.1460-9592.2003.00978.x

Cited by 49 publications

(24 citation statements)

References 14 publications

(16 reference statements)

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“…Severe bradycardia induced by remifentanil has been reported in numerous studies in adults [2][3][4] and in children [20][21][22]. In the overall analysis of the effects of remifentanil without atropine (REMI group), the lengthening of RR interval and the simultaneous increase of the HF component and rmssd suggested parasympathetic activation in the genesis of this bradycardia.…”

Section: Discussionmentioning

confidence: 89%

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

et al. 2005

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SummaryRemifentanil can cause bradycardia either by parasympathetic activation or by other negative chronotropic effects. The high frequency (HF) component of heart rate variability (HRV) is a marker of parasympathetic activity. This study aimed to evaluate the effect of remifentanil on RR interval and on HRV in children. Forty children ASA I or II were studied after approval by the human studies committee and informed parental consent was obtained. After stabilisation at sevoflurane 1 MAC, they were randomly divided into two groups: one received a 20 lg.kg atropine injection (AT + REMI) and the other ringer lactate solution (REMI). Three minutes later, a 1 lg.kg )1 bolus of remifentanil was administered over 1 min, followed by a continual infusion at 0.25 lg.kg )1 .min )1 for 10 min increased to 0.5 lg.kg )1 .min )1 for a further 10 min.A time varying, autoregressive analysis of RR sequences was used to estimate classical spectral parameters: low (0.04-0.15 Hz; LF) and high (0.15-0.45 Hz; HF) frequency, whereas the root mean square of successive differences of RR intervals (rmssd) was derived directly from the temporal sequence. Statistical analyses were conducted by means of the multiple correspondence analysis and with non parametrical tests. Remifentanil induced an RR interval lengthening, i.e. bradycardia, in both groups compared to pretreatment values and was associated with an increase of HF and rmssd only for the REMI group. The parasympathetic inhibition by atropine did not totally prevent remifentanil's negative chronotropic effect. A direct negative chronotropic effect of remifentanil is proposed.

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Section: Discussionmentioning

confidence: 89%

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

et al. 2005

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“…The effect of fentanyl on sevoflurane, which has been shown to be interchangeable with remifentanil in children, has been documented. 5,6 There exists a 1:1.5 potency ratio between fentanyl and remifentanil. 7 Zhang et al have shown that in children aged five to ten, an increase in fentanyl serum levels from 0.62 ± 0.13 µg·L -1 to 1.51 ± 0.18 µg·L -1 produces a decrease in sevoflurane MAC from 1.03 ± 0.07% to 0.64 ± 0.01%.…”

Section: Discussionmentioning

confidence: 99%

“…2,4 In children, remifentanil and fentanyl have been shown to be interchangeable clinically. 5,6 Remifentanil has been shown to have superior recovery characteristics and is effective at dosages much lower than those required for other commonly-used opioids such as fentanyl. 7 The effect of remifentanil in reducing the minimum alveolar concentration MAC-BAR of sevoflurane has been demonstrated in adults.…”

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confidence: 99%

Remifentanil decreases sevoflurane requirements in children

Castanelli

Splinter

Clavel

2005

Can J Anesth/J Can Anesth

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Purpose:To establish the effect of increasing concentrations of remifentanil on sevoflurane requirements in children.Methods: Fifty-eight healthy patients, ASA status I-II aged two to 12 yr, undergoing abdominal wall hernia or hydrocele repairs were serially assigned to one of four test groups to receive remifentanil 0.03 µg·kg -1 ·min -1 , 0.06 µg·kg -1 ·min -1 , 0.12 µg·kg -1 ·min -1 , or 0.25 µg·kg -1 ·min -1 iv. Patients received a bolus of remifentanil 1 µg·kg -1 iv before the infusion began. End-tidal sevoflurane concentration was adjusted according to a Dixon up-and-down approach. Ten minutes after starting the remifentanil infusion, the surgical incision was made. The patient was observed for one minute from the time of incision by a solitary blinded rater for either flexion or withdrawal of one or more extremities in response to skin incision. Results:The mean minimum alveolar concentration of sevoflurane was 2.39 ± 0.58 with 0.03 µg·kg -1 ·min -1 remifentanil, 1.91 ± 0.36 with 0.06 µg·kg -1 ·min -1 remifentanil, and 0.92 ± 0.11 with 0.12 µg·kg -1 ·min -1 remifentanil. Remifentanil 0.25 µg·kg -1 ·min -1 lead to the sevoflurane being decreased to a level associated with spontaneous patient awakening.The effective dose (ED 50 ) values of sevoflurane were 2.44 [95% confidence interval (CI) 2.16-2.72], 2.00 (95% CI 1.78-2.22), and 1.18 (95% CI 0.99-1.36) for remifentanil infusion rates of 0.03 µg·kg -1 ·min -1 , 0.06 µg·kg -1 ·min -1 , and 0.12 µg·kg -1 ·min -1 respectively. Conclusion:The administration of remifentanil produced a dose-dependent decrease in the minimum alveolar concentration of sevoflurane necessary for inhibition of movement reaction in response to surgical incision. The use of remifentanil may allow for flexible analgesic control and rapid recovery in children anesthetized with sevoflurane. (IC de 95 % 1,22) et 1,18 (IC de 95 % 0,36) Objectif

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“…It was observed that 1 µg kg -1 min -1 remifentanil infusion and PCA fentanil bolus administration were effective for analgesia. Robert et al (11) used fast-track anaesthesia protocol with remifentanil and fentanyl in pediatric cases and did not found any difference between postoperative analgesic requirements.…”

Section: Discussionmentioning

confidence: 98%

Effects of Remifentanil and Fentanyl on Postoperative Pain and Recovery in Fast-Tract Cardiac Surgery

Turan¹,

Ayik²,

Öztürk³

et al. 2013

GKDA Derg

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A comparison of remifentanil and fentanyl for fast track paediatric cardiac anaesthesia

Abstract: The remifentanil based anaesthetic was associated with a significantly slower HR than the fentanyl based anaesthetic. The clinical implications of the slower HR during remifentanil anaesthesia could be important and should be investigated.

Cited by 49 publications

References 14 publications

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

Remifentanil decreases sevoflurane requirements in children

Effects of Remifentanil and Fentanyl on Postoperative Pain and Recovery in Fast-Tract Cardiac Surgery

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