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Different small-dose remifentanil blunting the cardiovascular response to laryngoscopy and intubation in children: a randomized double-blind comparison

Published online by Cambridge University Press:  01 February 2008

F. S. Xue ,
Y. C. Xu ,
Y. Liu ,
Q. Y. Yang ,
X. Liao ,
K. P. Liu ,
C. W. Li  and
H. T. Sun
F. S. Xue*
Affiliation:
Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital, Department of Anaesthesiology, Beijing Xinxiang Medical College, Department of Anaesthesiology, Xinxiang, Henan, People’s Republic of China
Y. C. Xu
Affiliation:
Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital, Department of Anaesthesiology, Beijing
Y. Liu
Affiliation:
Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital, Department of Anaesthesiology, Beijing
Q. Y. Yang
Affiliation:
Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital, Department of Anaesthesiology, Beijing
X. Liao
Affiliation:
Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital, Department of Anaesthesiology, Beijing
K. P. Liu
Affiliation:
Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital, Department of Anaesthesiology, Beijing
C. W. Li
Affiliation:
Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital, Department of Anaesthesiology, Beijing
H. T. Sun
Affiliation:
Chinese Academy of Medical Sciences and Peking Union Medical College, Plastic Surgery Hospital, Department of Anaesthesiology, Beijing
*
Correspondence to: Fu-shan Xue, Department of Anaesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing 100041, People’s Republic of China. E-mail: fruitxue@yahoo.com.cn; Tel: +86 010 8870 3936; Fax: +86 010 8896 4137
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Summary

Background

The available data provide inconsistent results on the efficacy of small-dose remifentanil attenuating the cardiovascular response to intubation in children. Therefore, this randomized double-blind study was designed to assess the ability of different small doses of remifentanil on the cardiovascular intubation response in children, with the aim of determining the optimal dose of remifentanil for this purpose.

Methods

One hundred and twenty-four children aged 3–9 yr were randomized to one of four groups to receive the following in a double-blind manner: normal saline (Group 1), remifentanil 0.75 μg kg−1 (Group 2), remifentanil 1 μg kg−1 (Group 3) and remifentanil 1.25 μg kg−1 (Group 4). Non-invasive blood pressure and heart rate were recorded before anaesthesia induction (baseline value), immediately before intubation (postinduction values), at intubation and at 1 min intervals for 5 min after intubation.

Results

Tracheal intubation caused significant increases in systolic blood pressure and heart rate in Groups 1–3 compared with the baseline values. The maximum percent increases of systolic blood pressure and heart rate were 10% and 26% of the baseline values, respectively, in Group 2; 5% and 14% in Group 3; and 1% and 8% in Group 4 compared with 27% and 37% in Group 1. Except for the Group 3 vs. Group 4 comparison, there were significant differences among the four groups in the maximum percent increases of systolic blood pressure and heart rate.

Conclusions

When used as part of anaesthesia induction with propofol and vecuronium in children, bolus administration of remifentanil resulted in a dose-related attenuation of the cardiovascular intubation response.

Keywords

INTUBATIONINTRATRACHEALANAESTHESIA GENERALANALGESICS OPIOID, remifentanilCHILDRENCARDIOVASCULAR PHYSIOLOGICAL PHENOMENA, blood pressure, heart rate
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 2 , February 2008 , pp. 106 - 112
Copyright
Copyright © European Society of Anaesthesiology 2007

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Footnotes

The manuscript had been presented as a Poster Discussion at the 2006 Annual Meeting of the American Society of Anaesthesiologists in Chicago, IL, USA.

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