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PEDIATRIC ANESTHESIA

Dose-Response of Remifentanil for Tracheal Intubation in Infants

Department of Anaesthesia and the Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Address correspondence and reprint requests to Mark W. Crawford, MBBS, FRCPC, Department of Anesthesia, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, Canada M5G 1X8. Address e-mail to mark.crawford{at}sickkids.ca.

To compare the dose-response of remifentanil for tracheal intubation in infants and children, 32 healthy full-term infants and 32 children were anesthetized with 10 µg/kg glycopyrrolate and 4.0 mg/kg propofol and administered 1 of 4 doses of remifentanil (1.25, 1.50, 1.75, or 2.00 µg/kg) to facilitate tracheal intubation. We determined the effective doses of remifentanil in 50% (ED₅₀) and 98% (ED₉₈) of patients by using logistic regression analysis. We found that logistic regression curves were similar for infants and children (P = 0.38). ED₅₀ and ED₉₈ values for remifentanil were 1.70 ± 0.1 µg/kg and 2.88 ± 0.5 µg/kg, respectively. In a second double-blind study, 24 infants were anesthetized with propofol and randomized to receive either 3.0 µg/kg remifentanil or 2.0 mg/kg succinylcholine to facilitate tracheal intubation. The duration of apnea, tracheal intubating conditions and hemodynamic changes were determined. We found that the duration of apnea and intubating conditions after propofol/remifentanil were similar to those after propofol/succinylcholine. Bradycardia, hypotension, and chest wall rigidity did not occur. We conclude that the dose-response of remifentanil for tracheal intubation is similar in infants and children. Propofol/remifentanil provides clinically acceptable intubating conditions, stable hemodynamics, and a duration of apnea comparable to that with propofol/succinylcholine in infants.

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