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Anesth Analg 2007;104:77-80
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000251201.81210.e7

PEDIATRIC ANESTHESIA

Remifentanil Requirements During Propofol Administration to Block the Somatic Response to Skin Incision in Children and Adults

Hernán R. Muñoz, MD, MSc, Luis I. Cortínez, MD, Mauricio E. Ibacache, MD, and Fernando R. Altermatt, MD

From the Departamento de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Address correspondence and reprint requests to Hernán R. Muñoz, MD, Departamento de Anestesiología, Universidad Católica de Chile, Marcoleta 367, Santiago, Chile. Address e-mail to hmunoz{at}med.puc.cl.

BACKGROUND: During sevoflurane administration, children require a remifentanil infusion rate twofold higher than adults to block responses to skin incision. Similar data concerning remifentanil requirements are unavailable during total IV anesthesia.

METHODS: We prospectively determined the infusion rate (IR) of remifentanil necessary to block the somatic response to skin incision in 50% (IR50) of adults (n = 20, aged 20–60 yr) and children (n = 20, aged 3–11 yr) during propofol anesthesia. In each patient undergoing lower abdominal surgery, a remifentanil infusion was initiated, followed by target-controlled infusion of propofol set at a plasma concentration of 6 µg/mL. After tracheal intubation, propofol was reduced to 3 µg/mL until the end of the study. Remifentanil IR was determined according to Dixon's up-and-down method, with the first patient in each group receiving 0.2 µg · kg–1 · min–1 followed by the consecutive patient receiving 0.02 µg · kg–1 · min–1 modifications according to the response of the previous patient. The remifentanil IR was kept unchanged for at least 20 min before surgery. At the beginning of surgery, only the skin incision was performed, and the somatic response was observed. If there was any gross movement of extremity the response was considered positive.

RESULTS: The IR50 (CI95%) was 0.08 (0.06–0.12) µg · kg–1 · min–1 in adults and 0.15 (0.13–0.17) µg · kg–1 · min–1 in children (P < 0.001).

CONCLUSION: These results demonstrate that, similar to sevoflurane anesthesia, during total IV anesthesia with propofol, children require a remifentanil IR almost twofold higher than adults to block the somatic response to skin incision.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2007 by the International Anesthesia Research Society.