The Effects of Midazolam or Propofol Combined with Remifentanil Infusion for Central Venous Catheterization in Children

Abstract

Background: Midazolam or propofol has been used for the procedural sedation in children. However, the combined use of remifentanil have not been widely investigated. The purpose of this study was to evaluate the effectiveness and safety of remifentanil infusion with intravenous anesthetics during the central venous catheterization in children.Methods: After institutional review board approval and written informed consent from patients' parent, 20 children planned central venous catheterization for chemotherapy were randomly assigned into two groups. All patients were infused with remifentanil 0.1μg/kg/min. In M group, 0.3 mg/kg of midazolam bolus was injected and 0.1 mg/kg bolus were injected intermittently if the sedation was inadequate. In P group, 1.0 mg/kg of propofol bolus and 150μg/kg/min were infused. 0.5 mg/kg of propofol was given intermittently if the sedation was inadequate. Hemodynamic variables, end-tidal CO2 (EtCO2), bispectral index score (BIS) were monitored throughout the procedure.Results: There were no significant differences in hemodynamic variables, sedation and recovery times. Oxygen saturation (SpO2) in P group was significantly lower than that of M group at 15 min after the start of infusion. EtCO2 in P group was significantly higher than that of M group at 10 min after the start of infusion. Hypoxemia (SpO2 ＜ 90%) were occurred in three patients of P group. There was no significant difference in BIS among the groups.Conclusions: The combined infusion of remifentanil 0.1μg/kg/min with midazolam provided successful sedation without airway assistance during the central venous catheterization in children.

The cardiovascular effects of midazolam co-induction to propofol for induction in aged patients

“…Kang and Lee [ 27 ] reported a gradual decrease of systolic and diastolic pressures in the group coadministered with remifentanil and propofol as well as in the group co-administered with remifentanil and midazolam, but the hemodynamic differences between the two groups were not significant, in connection with the effects of remifentanil on the cardiovascular actions of midazolam and propofol. Also, Ryu et al [ 28 ] reported that when the central venous catheterization is used in pediatric patients, there was no significant difference in the intraoperative mean arterial pressure and in the intraoperative heart rate from both of the groups with the co-administration of remifentanil and midazolam, as well as the group with the co-administration of remifentanil and propofol. Therefore, in this study, the cardiovascular effects of remifentanil in the two groups can be assumed to be equal when it was administered under the same conditions, and it is considered that the administration of remifentanil in addition to propofol and midazolam had achieved unconsciousness, response blocking to harmful stimulation and amnesia by using the interactive synergistic actions between drug agents.…”