Dose of remifentanil for minimizing the cardiovascular changes to tracheal intubation in pediatric patients

Abstract

BackgroundThe purpose of this study was to investigate a dosage of remifentanil for attenuating cardiovascular changes during anesthetic induction in pediatric anesthesia.MethodsWe examined the effect of remifentanil on the cardiovascular responses to intubation in 90 children ASA 1 patients, aged 4-15 years, randomly allocated to receive 1.0 ug/kg remifentanil as a bolus (R 1), or 1.5 ug/kg remifentanil (R 1.5), or 2.0 ug/kg remifentanil (R 2). Before induction, IV midazolam 0.05 mg/kg was given for sedation. After glycoppylorate 5 ug/kg, thiopental 4.0 mg/kg was injected within 10 seconds and followed by remifentanil. Following check the unconsciousness, patients were received rocuronium 0.6 mg/kg and tracheal intubation were performed 90s later, and anesthesia was maintained with 2% sevoflurane in air/oxygen. Systolic arterial pressure (SAP), mean arterial pressure (MAP) and heart rate (HR) were measured at before induction of anesthesia (B), before, just after and at 1, and 3 minutes after tracheal intubation.ResultsSAP and HR were increased than B values in the three groups just after intubation (P < 0.05). The percentage increases of SAP and HR were 30% and 30% of B values, respectively, in R 1; 19% and 24% in R 1.5; 10% and 22% in R 2. There were significant differences between R 2 group and other two groups in SAP and HR (P < 0.05).ConclusionsIn pediatric anesthesia, a bolus injection of 2 ug/kg remifentanil (R 2) was a dosage to attenuate the cardiovascular responses after intubation in pediatric patients.

Management of the airway without the use of neuromuscular blocking agents: the use of remifentanil

“…effectively attenuate the sympathetic response, even the prolongation of the QTc (the heart rate-corrected distance between the beginning of the QRS wave and the end of the T wave in the electrocardiography) interval [6], to laryngoscopy, endotracheal intubation [7][8][9], and incision [10,11]. According to recent studies, remifentanil (1 lg/kg), in combination with thiopental and rocuronium, is more effective than lidocaine (1.5 mg/kg) and esmolol (1 mg/kg) for blunting the haemodynamic responses to intubation in normotensive adults [12], and a bolus dose of 2 lg/kg remifentanil was enough to attenuate the sympathetic response in pediatric patients aged 4-15 [13]. In a very recent study, Cafiero et al recommended the use of remifentanil infusion (0.25 lg/kg/min) in patients with risk factors for dysrhythmias, as it prevents the increase in the QT (the distance between the beginning of the QRS wave and the end of the T wave in the electrocardiography) dispersion after intubation in comparison with fentanyl [14].…”

Optimal neuromuscular blocking effects of remifentanil during tracheal intubation under general anesthesia

“… 12 , 14 Several studies have shown that remifentanil causes cardiovascular compromise during induction, which in turn alleviates the sympathetic stimulation caused by endotracheal intubation. 15 These studies proved that remifentanil decreases the systemic circulation. Therefore, continuous infusion of remifentanil at different doses affects neuromuscular pharmacodynamics.…”

Pharmacological Agents for Reducing the Haemodynamic Response to Tracheal Intubation in Paediatric Patients: A Systematic Review

“…The flow chart of the literature search and study selection is shown in Figure 1. We identified 31 articles but only 16 publications met our criteria [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] . Details of drugs used, dosage, route, observations and cardiac rhythm disturbances related to the response are shown in Table 1.…”

“…One study 16 documented the changes as more than 30% change from baseline and one study 15 measured the percentage change in BP and HR. Eight studies 8,[10][11][12]14,18,21,23 presented results as graphs alone.…”