title: Remifentanil prevents withdrawal movements caused by intravenous injection of rocuronium.
abstract: OBJECTIVE
  The incidence of pain induced withdrawal movement following intravenous injection of rocuronium is high. This randomized, double-blind, placebo-controlled study was designed to evaluate the effect of pretreatment of remifentanil on the withdrawal movements due to intravenous injection of rocuronium during anesthetic induction.
  
  
  METHODS
  Ninety adult female patients undergoing thyroidectomy were randomly allocated to three groups. Each patient intravenously received one of three solutions of equal volume (4 mL): normal saline (Group I, n=30), 0.5 microg/kg remifentanil (Group II, n=30) or 1 microg/kg remifentanil (Group III, n=30). Thirty seconds after remifentanil administration, anesthesia was induced with 5 mg/kg IV thiopental. Twenty seconds after thiopental injection, 0.6 mg/kg IV rocuronium was administered (injection rate of 0.5 mL/sec) and patients' withdrawal movements were assessed. Mean arterial pressure (MAP) and heart rate were assessed on arrival in the operation room, before the tracheal intubation and immediately, 1 and 2 min after the tracheal intubation.
  
  
  RESULTS
  The incidence of withdrawal movements was significantly lower in both of the remifentanil groups (3 and 0% in Group II and III, respectively) than in the saline group (70%). Remifentanil attenuated the increase of heart rate and MAP immediately and 1 min after the tracheal intubation.
  
  
  CONCLUSIONS
  The pretreatment with 0.5 and 1.0 microg/kg remifentanil of bolus doses prevented the withdrawal movements caused by rocuronium injection, and effectively blunted cardiovascular activation following tracheal intubation.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea.
authors.forename: Byung In
authors.initials: BI
authors.lastname: Choi
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Yang-Sik
authors.initials: YS
authors.lastname: Shin
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Kyung Bong
authors.initials: KB
authors.lastname: Yoon
authors.forename: Seo Kyung
authors.initials: SK
authors.lastname: Shin
authors.forename: Ki-Young
authors.initials: KY
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000732:Androstanols / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous / Q000009:adverse effects; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010880:Piperidines / Q000008:administration & dosage / Q000627:therapeutic use*; D000077208:Remifentanil; D000077123:Rocuronium
chemical_list: D000701:Analgesics, Opioid; D000732:Androstanols; D010880:Piperidines; D000077208:Remifentanil; D000077123:Rocuronium