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

Klemola, Ulla-Maija; Hiller, Arja

doi:10.1007/bf03019664

Cited by 49 publications

(64 citation statements)

References 27 publications

(32 reference statements)

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“…Muscle rigidity has been observed in 11-32% of neonates with target concentrations of remifentanil between 2 ng/ml and 16 ng/ml. 10 However, it is noteworthy that none of our neonates had this complication, probably because we used a slower rate of administration of remifentanil.…”

Section: Discussionmentioning

confidence: 80%

Morphine versus remifentanil for intubating preterm neonates

Silva

Gomez

Marcatto

et al. 2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

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A double-blind, randomised controlled study was conducted to evaluate the intubation conditions in 20 preterm neonates following the use of either morphine or remifentanil as premedication. The findings suggest that the overall intubation conditions were significantly better (p = 0.0034) in the remifentanil group than in the morphine group. No severe complications were observed in either group. E ndotracheal intubation of preterm neonates forms a major part of routine practice in the neonatal intensive care unit (NICU). This procedure is associated with physiological and biochemical responses, and premedication (sedation and analgesia) seems to improve physiological stability and decrease the time taken for and the level of difficulty of the procedure.1 Morphine has been used for several years in most NICUs with apparent safety and efficacy, and midazolam is given for sedation. However, morphine has several limitations, the main one being its delayed onset of action, which makes the drug unsuitable for premedication.1 2 In this setting, remifentanil has theoretical and practical advantages over other sedative drugs, making it appropriate for noxious procedures such as intubation and ventilation. 4 The aim of our randomised double-blind study was to compare the intubation conditions achieved following sedation with remifentanil and morphine in preterm neonates with respiratory distress syndrome (RDS). PATIENTS AND METHODSOur study population included 20 preterm neonates (28-34 weeks' gestation) admitted to a single tertiary NICU, who required elective tracheal intubation to treat respiratory failure due to RDS. The ethics committee of our institution approved the study, and informed consent was obtained from parents of all selected neonates. Neonates were excluded from the study if they had major congenital malformations, birth weight less than 1000 g, previous or concurrent use of opioids or haemodynamic instability before intubation.Following enrolment the neonates were randomised sequentially, using a random numbers table, to receive an intravenous bolus injection over 1 min of either morphine 150 mg/kg and midazolam 200 mg/kg or remifentanil 1 mg/kg and midazolam 200 mg/kg. A single pharmacist was responsible for allocating each neonate in the randomised treatment group, and she also ensured that the two preparations could not be differentiated.The neonates were preoxygenated with 100% oxygen and a monitor (Dixtal 2010; Dixtal Collaborative Evolution, São Paulo, Brazil) recorded the heart rate, blood pressure and oxygen saturation (SaO 2 ). A single paediatric anaesthetist, who was blinded to the study protocol, carried out all intubations and classified the intubation conditions as poor, good or excellent. 5 The intubation conditions were scored using a four-point scale and the variables assessed were: ease of laryngoscopy, position of the vocal cords, coughing, jaw relaxation and movement of the limbs. 5The blood pressure, heart rate and SpO 2 were recorded before and during the first 10 min after the intub...

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Section: Discussionmentioning

confidence: 80%

Morphine versus remifentanil for intubating preterm neonates

Silva

Gomez

Marcatto

et al. 2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…In addition, complications of depolarizing and non-depolarizing muscle relaxants and their antagonists and the resultant prolongation of the recovery period can be averted by avoiding their administration. A combination of remifentanil and propofol has been used for endotracheal intubation in patients of at different ages (children and adults) (1,(21)(22)(23), and the doses of 3 mcg/kg and 3 mg/kg for remifentanil and propofol, respectively, were found to provide desirable conditions for intubation (21). In adult patients who received iv midazolam and lidocaine before remifentanil (2 mcg/kg) and propofol (2 mg/kg) had better intubation conditions compared to those receiving thiopental (5 mg/kg) after 2.…”

Section: Comparison Of Remifentanil and Alfentanil Imani F Et Almentioning

confidence: 99%

Use of Remifentanil and Alfentanil in Endotracheal Intubation: A Comparative Study

Imani¹,

Faiz²,

Alebouyeh³

et al. 2011

Anesth Pain

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A B S T R A C TBackground: Opioids, such as alfentanil, are used to facilitate endotracheal intubation without the use of neuromuscular blocking agents in patients undergoing elective surgery. Objectives: The goal of this study was to evaluate the endotracheal intubation conditions when remifentanil or alfentanil was used with propofol without the application of neuromuscular blocking agents. Patients and Methods: One hundred American Society of Anesthesiologists (ASA) grade I patients scheduled for elective surgery were enrolled in this prospective, randomized, triple-blinded study. The patients were randomized to group A (alfentanil) or R (remifentanil). In group A, alfentanil (50 mcg/kg) was intravenously injected over 10 seconds, and after 45 seconds or at the occurrence of apnea, propofol (2 mg/kg) was intravenously injected over 5 seconds. Thirty seconds after the administration of propofol, laryngoscopy and endotracheal intubation were attempted. In group R, remifentanil (5 mcg/kg) was administered instead of alfentanil. Intubation conditions, including ease of laryngoscopy, patency of the vocal cords, jaw relaxation, limb movement (1-4 score), and also, demographic data were evaluated. Results: There were no demographic data diffrerences between groups (age, weight, and sex). Further, laryngoscopy, jaw relaxation, and limb movement scores were similar in the R and A groups and there were no significant differences, but vocal cords were significantly more patent in group R than those in group A (P = 0. 028). Conclusions:The results of this study showed that remifentanil, similar to alfentanil, provided excellent conditions for endotracheal intubation when used with propofol for the induction of anesthesia; however, remifentanil improved the patency of the vocal cords to a greater extent than alfentanil.

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“…Klemola et al [10] also found a 12% fall in MAP and 8% fall in HR with a dose combination of 4.0 mg/kg remifentanil and 3.5 mg/kg propofol, while de Fatima et al [5] did not find any significant changes in hemodynamics. This fall in cardiac output may not be well tolerated in high-risk patients, where it could become significant.…”

Section: Discussionmentioning

confidence: 95%

“…During laryngoscopy and intubation, each patient was assessed for five variables namely; ease of laryngoscopy, position of vocal cords, degree of coughing, jaw relaxation, and limb movements and scored accordingly [8]. The tracheal intubating conditions were graded based on scoring system devised by Helbo-Hansenet al [7], which includes three criteria; ease of laryngoscopy, degree of coughing, and position of vocal cords.…”

Section: Patient and Methodsmentioning

confidence: 99%

“…In addition two further criteria, jaw relaxation, and limb movements were also observed as modified by Steynet al [9]. The sum of the scores of these five individual variables was computed as the Helbo-Hansen (Steyn's modification, Table 1) score [10]. Total score of 5 was considered to be excellent, 6-10 good, 11-15 poor, and 16-20 bad.…”

Section: Patient and Methodsmentioning

confidence: 99%

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