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

Abstract

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.

Effect of Low Dose Remifentanil on Postoperative Pain Relief and Heart Rate Variability in Post-Anaesthesia Care Unit

“…This may indicate that lowdose remifentanil induces parasympathetic nerve activation without adverse hemodynamic or respiratory effects. This is partly inconsistent with previous reports, where remifentanil did not trigger the activation of the parasympathetic nervous system (5)(6)(7)(8). This difference may be partly attributable to the clinical presentation and demographics of the patients studied; the subjects for the study by Tirel et al (5) were children whereas our study subjects were adults.…”

“…Fujiwara et al (3) showed that spinal anaesthesia induced a decrease of both sympathetic and parasympathetic nerve activities. Several reports describe the effects of opioids on the activity of the sympathetic or parasympathetic nervous system (4)(5)(6)(7)(8). Carter et al (4) examined the effects of morphine on sympathetic nerve activity in humans and found that the intravenous injection of morphine increased sympathetic nerve activity.…”

“…Tirel et al (5) examined the effects of remifentanil on HRV in children under 1 MAC of sevoflurane anaesthesia, and found that although remifentanil provoked bradycardia, this was not related to the activation of the parasympathetic nervous system. In contrast, Shinohara et al (7) showed that renal sympathetic nerve activity in rabbits was increased after a bolus injection of remifentanil.…”

“…Carter et al (4) examined the effects of morphine on sympathetic nerve activity in humans and found that the intravenous injection of morphine increased sympathetic nerve activity. Tirel et al (5) investigated the effects of remifentanil on HRV in children who were administered sevoflurane anaesthesia at one minimum alveolar concentration (MAC), and reported that remifentanil (administered as a continuous infusion of 0.25 µg kg −1 min −1 for 10 min, then increased to 0.5 µg kg −1 min −1 ) reduced the inter-beat (RR) interval, but had little effect on parasympathetic nerve activity.…”

Selection of Anesthesia Techniques for the Neonate

“…However, evidence suggests that the rate of recovery after remifentanil in neonates less than 1 week old may be greater than it is in infants 7 days to 3 months of age [ 256 ]. Pharmacodynamically, remifentanil may induce bradycardia, an effect classically attributed to the parasympathomimetic properties of remifentanil, a direct negative chronotropic effect [ 257 ]. The decrease in heart rate attributable to remifentanil after 5 μg/ kg was infused over 1 min, peaks at 3 and 5 min after the infusion, but was less impressive in infants ≤2 months than in older children, although only 8 infants ≤2 months were included [ 258 ].…”