Prevention of withdrawal movement associated with injection of rocuronium in children: comparison of remifentanil, alfentanil and fentanyl

Oh, Ah Young; Seo, Kwang-Suk; Goo, Eui-Kyoung; Park, Y. O.; Kim, S. J.; Kim, J. H.

doi:10.1111/j.1399-6576.2007.01371.x

Cited by 28 publications

(26 citation statements)

References 13 publications

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“…Pain upon intravenous infusion has been reported, though premedication with analgesics have been studied, and fentanyl was noted to decrease pain responses in one study. 34 Optimal dosing to maximize the number of completely paralyzed patients, provide quick onset of action, and minimize duration of paralysis in the neonatal and infant populations requires further investigation.…”

Section: Drug Of Choicementioning

confidence: 99%

Rocuronium for nonemergent intubation of term and preterm infants

et al. 2010

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Objective: The aim of this study was to analyze clinical characteristics of rocuronium as premedication for nonemergent intubation in infants.Study Design: Preterm infants requiring nonemergent intubation were randomized to receive atropine and fentanyl with or without rocuronium. Outcomes, patient characteristics and intubator's experience were noted. Onset, duration and degree of clinical paralysis were recorded for rocuronium group and for older infants receiving rocuronium per unit protocol.Result: Forty-four intubations were randomized (20 rocuronium, 24 control). Groups were similar in chronological and corrected gestational age, weight and intubator's experience. Successful intubation on first attempt was achieved in 35% of intubations under rocuronium vs 8% of controls; rocuronium was the only significant variable by logistic regression (odds ratio ¼ 0.052, P ¼ 0.029). Complete paralysis was reported in 80% of 57 rocuronium intubations; onset ranged from 14 to 178 s (65.9±43.4), and duration from 1 to 60 min (16.3 ± 13.5).Conclusion: Rocuronium facilitated successful intubation and provided clinical paralysis quickly in most infants.

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Section: Drug Of Choicementioning

confidence: 99%

Rocuronium for nonemergent intubation of term and preterm infants

et al. 2010

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“…Besides lidocaine, several other drugs such as ondansetron [8,9], magnesium sulfate [10], sodium bicarbonate [10,15], fentanyl [16,17], and remifentanil [18,19] are effective in reducing pain on rocuronium injection, but pretreatment of lidocaine or other drugs before rocuronium prolongs the time between anesthesia induction and neuromuscular block administration. In addition, most of these drugs can, even in rare cases, induce adverse effects such as allergic reaction, bradycardia, and hypotension.…”

Section: Discussionmentioning

confidence: 99%

Rapid injection of rocuronium reduces withdrawal movement on injection

Lee

Jang

Kim

et al. 2009

Journal of Clinical Anesthesia

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“…cannula. Withdrawal movements were observed by the same blinded investigator using a 4-point scale: 0 = no movement; 1 = movement limited to the wrist; 2 = movement limited to the arm; and 3 = generalized movement [2,6]. A grade of 2 or more was considered significant movements.…”

Section: Methodsmentioning

confidence: 99%

“…It has a rapid onset and an ultra-short duration of action with a stable, short context-sensitive half-time [5]. Many studies have reported that remifentanil effectively reduces rocuronium-induced pain and withdrawal movements [6,7,8,9]. There have recently been studies on the EC 50 and EC 95 of remifentanil to prevent withdrawal movements in adults [4,10] and children [10] using the Dixon up-and-down method and by probit analysis.…”

Section: Introductionmentioning

confidence: 99%

EC₅₀and EC₉₅of remifentanil to prevent rocuronium-induced withdrawal movements in children

Park

Kim

et al. 2014

Korean J Anesthesiol

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BackgroundIntravenous administration of rocuronium induces intense pain in most patients (60-100%). This could be harmful during anesthesia induction because of the unintended reflex movement of an unconscious patient in response to the pain. Previous studies have reported that remifentanil effectively reduces rocuronium-induced pain and withdrawal movements. This study was designed to evaluate the EC50 and EC95 of remifentanil to prevent withdrawal movements in children.MethodsWe enrolled a total of 171 pediatric patients scheduled for general anesthesia in this study. Remifentanil was administrated by target-controlled infusion. Effect-site target concentrations ranged from 0.5 to 3.0 ng/ml. At each concentration, experiments were repeated in 10-20 patients. Propofol 2 mg/kg and rocuronium 0.9 mg/kg were administrated after equilibration of plasma and effect-site target remifentanil concentration. The withdrawal movements were graded on a 4-point scale. The EC50 and EC95 of remifentanil to prevent rocuronium-induced withdrawal movements were determined by using a logistic regression model.ResultsThe logistic regression model showed that the probability of preventing rocuronium-induced withdrawal movement was as follows: exp (-3.49 + 2.07 × remifentanil concentration) / (1 + exp [-3.49 + 2.07 × remifentanil concentration]). EC50 and EC95 were 1.69 ng/ml (95% confidence intervals [CIs], 1.42-1.87) and 3.11 ng/ml (95% CIs, 2.79-3.72), respectively.ConclusionsAdministration of remifentanil at an effect-site target concentration of 3.1 ng/ml could effectively prevent rocuronium-induced withdrawal movements.

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Prevention of withdrawal movement associated with injection of rocuronium in children: comparison of remifentanil, alfentanil and fentanyl

Cited by 28 publications

References 13 publications

Rocuronium for nonemergent intubation of term and preterm infants

Rocuronium for nonemergent intubation of term and preterm infants

Rapid injection of rocuronium reduces withdrawal movement on injection

EC₅₀and EC₉₅of remifentanil to prevent rocuronium-induced withdrawal movements in children

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Prevention of withdrawal movement associated with injection of rocuronium in children: comparison of remifentanil, alfentanil and fentanyl

Cited by 28 publications

References 13 publications

Rocuronium for nonemergent intubation of term and preterm infants

Rocuronium for nonemergent intubation of term and preterm infants

Rapid injection of rocuronium reduces withdrawal movement on injection

EC50and EC95of remifentanil to prevent rocuronium-induced withdrawal movements in children

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EC₅₀and EC₉₅of remifentanil to prevent rocuronium-induced withdrawal movements in children