title: Dose-response of remifentanil for tracheal intubation in infants.
abstract: 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 mug/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 microg/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 microg/kg and 2.88 +/- 0.5 microg/kg, respectively. In a second double-blind study, 24 infants were anesthetized with propofol and randomized to receive either 3.0 microg/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.
authors.affiliation: Department of Anaesthesia and the Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Crawford
authors.forename: Jason
authors.initials: J
authors.lastname: Hayes
authors.forename: Juliana M
authors.initials: JM
authors.lastname: Tan
mesh_terms: D000375:Aging / Q000502:physiology; D000465:Algorithms; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001835:Body Weight / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D008297:Male; D010880:Piperidines / Q000008:administration & dosage; D000077208:Remifentanil
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil