Effect of remifentanil on the haemodynamic response to orotracheal intubation

Thompson, J. P.; Hall, A. P.; Russell, J. A.; Cagney, B.; Rowbotham, David J.

doi:10.1093/bja/80.4.467

Cited by 169 publications

(86 citation statements)

References 12 publications

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“…These findings are in agreement with adult studies, which demonstrated significant decreases in MAP when higher doses of remifentanil were used either as a bolus or continuous infusion. 17,18 The decrease in CBFV prior to tracheal intubation seemed to coincide with a decrease in MAP in the present study, suggesting that remifentanil may be associated with impaired cerebral blood pressure autoregulation. Alternatively, remifentanil may have decreased MAP to pressures below the lower limit of cerebral autoregulation.…”

Section: Objectifsupporting

confidence: 59%

Fentanyl is more effective than remifentanil at preventing increases in cerebral blood flow velocity during intubation in children

Abdallah

Karsli

Bissonnette

2002

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Controlling the cerebral and systemic hemodynamic responses to laryngoscopy and tracheal intubation may play a role in determining clinical outcome in pediatric neurosurgical patients. This study compared the effects of remifentanil and fentanyl on cerebral blood flow velocity (CBFV) and hemodynamic profile during laryngoscopy and tracheal intubation in children under sevoflurane anesthesia.M Me et th ho od ds s: : Sixty healthy children aged two to six years undergoing dental surgery under general anesthesia were enrolled. Each child was randomly assigned to receive a remifentanil or fentanyl infusion, at a rate of 0.75, 1.0, or 1.5 µg·kg -1 ·min -1 after induction of anesthesia with 2% sevoflurane. Middle cerebral artery blood flow velocity was measured by transcranial Doppler (TCD) sonography. Once a baseline set of hemodynamic variables and TCD measurements were recorded, the opioid infusion was started. Measurements were taken at two-minute intervals, starting four minutes prior to laryngoscopy until four minutes following naso-tracheal intubation.R Re es su ul lt ts s: : Remifentanil caused a more significant decrease in mean arterial pressure and CBFV prior to tracheal intubation than did fentanyl (P < 0.001). During laryngoscopy and for two minutes following tracheal intubation, CBFV increased in all remifentanil groups (P < 0.05), whereas it remained stable in all fentanyl groups. C Co on nc cl lu us si io on n: : This study suggests that fentanyl was more effective than remifentanil at preventing increases in CBFV during and immediately following laryngoscopy and tracheal intubation in children undergoing sevoflurane anesthesia. Fentanyl also seemed to provide a more stable hemodynamic profile prior to laryngoscopy and tracheal intubation when compared to remifentanil. ARYNGOSCOPY and tracheal intubation may cause significant cerebral and systemic hemodynamic responses, including tachycardia, hypertension and increased intracranial pressure. [1][2][3] Controlling these responses on induction of anesthesia may be an important factor in improving outcome in pediatric neurosurgical patients. Remifentanil is a µ-opioid receptor agonist, rapidly metabolized by nonspecific esterases throughout the blood and tissues. The elimination half-life of remifentanil is less than ten minutes, compared to 219 min for fentanyl. 4-6 It does not accumulate after prolonged continuous infusion and the blood brain equilibration time is rapid. 5,7 Its use is characterized by rapid and complete offset of opioid effects within minutes of infusion discontinuation. 4 These distinctive pharmacokinetic and pharmacodynamic characteristics make remifentanil a potentially attractive opioid for use in pediatric anesthesia. Comparative data assessing cerebral blood flow velocity (CBFV) on induction and tracheal intubation with remifentanil and fentanyl has not been documented in the pediatric population. ObjectifThe aim of this study was to compare the effects of remifentanil and fentanyl on CBFV and hemodynamic...

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Section: Objectifsupporting

confidence: 59%

Fentanyl is more effective than remifentanil at preventing increases in cerebral blood flow velocity during intubation in children

Abdallah

Karsli

Bissonnette

2002

Can J Anesth/J Can Anesth

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“…Without a concurrent anticholinergic agent remifentanil was associated with bradycardia or hypotension, or both, in 30-50% of healthy patients during anesthetic induction and intubation. 10,11,28 On this basis, we considered the administration of an anticholinergic agent necessary, which might have contributed also to the observed stability of heart rate in our study in contrast to the results obtained without using an anticholinergic agent. In the present study, the cardiovascular intubation response was totally prevented in the groups receiving 2 or 4 µg·kg -1 remifentanil.…”

Section: Discussionmentioning

confidence: 94%

Tracheal intubation after induction of anesthesia in children with propofol — remifentanil or propofol-rocuronium

Klemola

Hiller

2000

Can J Anesth/J Can Anesth

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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...

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“…A variety of interventions [1][2][3][4][5][6] have been examined as possible stabilisers of the cardiovascular response, but none of these interventions have resulted in stable induction of anaesthesia because of either the inadequacy of their effect or unwanted sideeffects. It would be of great help if we could predict the haemodynamic response to induction of general anaesthesia.…”

mentioning

confidence: 99%

Correlation between heart rate variability and haemodynamic fluctuation during induction of general anaesthesia: comparison between linear and non‐linear analysis*

et al. 2007

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SummaryThe objective of this study was to compare linear and non-linear analysis of heart rate variability (HRV) in terms of correlation with haemodynamic fluctuation during induction of general anaesthesia. Pre-operatively, HRV was estimated by the MemCalc method in 114 patients scheduled for general anaesthesia. After anaesthesia was induced with propofol, fentanyl and vecuronium bromide, tracheal intubation was performed. Haemodynamic fluctuations during induction of anaesthesia were recorded and the correlation between pre-operative HRV and haemodynamic fluctuation was examined using logistic regression analysis. As an index of non-linear analysis of HRV, ultra short-term entropy (UsEn) correlated better with blood pressure fluctuation than did the ratio of the power of low frequency component of HRV to that of high frequency component (LF ⁄ HF). In contrast, although LF ⁄ HF significantly correlated with heart rate increase caused by tracheal intubation, the correlation between UsEn and heart rate fluctuation was not significant. Recently, some investigators have found linear analysis of heart rate variability (HRV) to predict the incidence of hypotension caused by induction of general [7] or spinal anaesthesia [8,9]. While frequency-domain measures of HRV, such as spectral analysis, focus on the status of cardiac autonomic activity, it is proposed that non-linear indices may provide insight into the overall structure of the heart rate regulating system. Although it was reported that pre-operative point dimension correlation (PD2), as a non-linear index of HRV, predicted hypotension after spinal anaesthesia [10], there is no previous report examining the correlation between non-linear index of HRV and circulatory response to induction of general anaesthesia.The MemCalc method, which is a combination of the maximum entropy method for spectral analysis and the non-linear least squares method for fitting analysis (Tarawa, Suwa Trust, Tokyo, Japan), has recently been developed [11,12]. This method enables us to estimate reliable HRV from a series of RR intervals over 30 s and recognises the abnormal RR interval of premature beats or artefacts, including noise, and removes it automatically. The MemCalc method does not cause distortion of the power calculation even if the underlying variation is changed, e.g. a change in respiration. When compared to

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Effect of remifentanil on the haemodynamic response to orotracheal intubation

Cited by 169 publications

References 12 publications

Fentanyl is more effective than remifentanil at preventing increases in cerebral blood flow velocity during intubation in children

Fentanyl is more effective than remifentanil at preventing increases in cerebral blood flow velocity during intubation in children

Tracheal intubation after induction of anesthesia in children with propofol — remifentanil or propofol-rocuronium

Correlation between heart rate variability and haemodynamic fluctuation during induction of general anaesthesia: comparison between linear and non‐linear analysis*

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