Prevention of rocuronium-induced withdrawal movement in children: a comparison of remifentanil with alfentanil.
BACKGROUND
This study was designed to compare the efficacy of remifentanil and alfentanil without the venous occlusion technique in preventing the withdrawal response associated with rocuronium injection in children.


METHODS
One hundred and twenty children aged between 3 and 10 years were randomly allocated into one of four groups to receive either i.v. remifentanil 0.5 microg.kg(-1) (remi 0.5 group), remifentanil 1 microg.kg(-1) (remi 1.0 group), alfentanil 15 microg.kg(-1) (alfentanil group) or saline 5 ml (saline group). Anesthesia was induced with 2.5% thiopental sodium 5 mg.kg(-1) and the test drug was injected over 30 s. One minute later, 1% rocuronium 0.6 mg.kg(-1) was injected over 5 s and the response was recorded. Mean arterial pressure (MAP) and heart rate (HR) were recorded on arrival in the operating room, before and 1 min after tracheal intubation.


RESULTS
The incidence of withdrawal movement in the saline group (93%) was significantly higher than that in the remi 0.5, remi 1.0, and alfentanil groups (53%, 17%, and 20%, respectively) (P < 0.05). The incidence in the remi 1.0 and alfentanil groups was significantly less than that in the remi 0.5 group (P < 0.05). After intubation, MAP and HR were significantly higher in the saline group than that in remi 1.0 and alfentanil groups.


CONCLUSIONS
Both remifentanil 1 microg.kg(-1) and alfentanil 15 microg.kg(-1) can be used to prevent rocuronium-associated withdrawal movement in children because they are equally effective and attenuate the increase in MAP and HR after intubation.
Kim
Jong Yeop
JY
Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea.
Kwak
Hyun Jeong
HJ
Kim
Ji Young
JY
Park
Kwan Sik
KS
Song
Jae Seok
JS
D015760:Alfentanil / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000732:Androstanols / Q000009:adverse effects*; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D009068:Movement / Q000187:drug effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010880:Piperidines / Q000627:therapeutic use*; D011446:Prospective Studies; D000077208:Remifentanil; D000077123:Rocuronium
D000701:Analgesics, Opioid; D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D015760:Alfentanil; D000077208:Remifentanil; D000077123:Rocuronium