Key result
Remifentanil 2 microg/kg bolus completely abolished the cardiovascular intubation response compared to sufentanil, but caused significantly more adverse cardiovascular depression.
Why the study?
Does remifentanil compared to sufentanil better blunt the cardiovascular response to intubation in healthy children undergoing general anesthesia?
RCT (n=105)
Double-blind
randomized
Does remifentanil compared to sufentanil better blunt the cardiovascular response to intubation in healthy children undergoing general anesthesia?
Remifentanil 2 microg/kg bolus is more effective than sufentanil 0.2 microg/kg at blunting intubation responses in children but carries a higher risk of significant hypotension and bradycardia.
Warrants caution against remifentanil 2 μg/kg bolus in healthy children due to hemodynamic risks; extends RCT data on opioid selection for intubation responses.
BACKGROUND AND OBJECTIVE: The present randomized controlled study was designed to compare the efficacy of remifentanil 2 microg kg(-1) and sufentanil 0.2 microg kg(-1) by bolus injection on the cardiovascular response to intubation in healthy children. METHODS: One hundred and five children, ASA 1-2 and scheduled for elective plastic surgery under general anaesthesia, were randomly divided into one of two study groups to receive the following treatments in a double-blind manner: remifentanil 2 microg kg(-1) (group R) and sufentanil 0.2 microg kg(-1) (group S). Blood pressure and heart rate (HR) were recorded before anaesthesia induction (baseline values), immediately before intubation (postinduction values), at intubation and every minute for 5 min after intubation. The percentage changes in systolic blood pressure (SBP) and HR relative to baseline values were calculated. The incidences of SBP and HR percentage changes of more than 30% of baseline values during the observation were recorded. RESULTS: As compared with baseline values, blood pressure and HR at intubation and their maximum values during the observation increased significantly in group S, but decreased significantly in group R. Blood pressure and HR at intubation and their maximum values during the observation were significantly different between the groups. There were significant differences between the groups in the percentage changes of SBP and HR relative to baseline values and their maximum percentage changes during the observation. The incidences of SBP and HR percentage increases of more than 30% of baseline values were not significantly different between the groups, but the incidences of SBP and HR percentage decreases of more than 30% of baseline values were significantly higher in group R than in group S. CONCLUSION: In combination with propofol for anaesthesia induction in children, sufentanil 0.2 microg kg(-1) by bolus injection fails to depress the cardiovascular intubation response. Remifentanil 2 microg kg(-1) by bolus injection can completely abolish the cardiovascular intubation response, but causes more adverse cardiovascular depression.
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Liao et al. (2009) conducted an RCT in Healthy children scheduled for elective plastic surgery (n=105). Remifentanil vs. Sufentanil 0.2 microg kg(-1) bolus was evaluated on Cardiovascular response to intubation (percentage changes in systolic blood pressure and heart rate). Remifentanil 2 microg/kg bolus completely abolished the cardiovascular intubation response compared to sufentanil, but caused significantly more adverse cardiovascular depression.
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