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Different small-dose remifentanil blunting the cardiovascular response to laryngoscopy and intubation in children: a randomized double-blind comparison

  • F. S. Xue (a1) (a2), Y. C. Xu (a1), Y. Liu (a1), Q. Y. Yang (a1), X. Liao (a1), K. P. Liu (a1), C. W. Li (a1) and H. T. Sun (a1)...



The available data provide inconsistent results on the efficacy of small-dose remifentanil attenuating the cardiovascular response to intubation in children. Therefore, this randomized double-blind study was designed to assess the ability of different small doses of remifentanil on the cardiovascular intubation response in children, with the aim of determining the optimal dose of remifentanil for this purpose.


One hundred and twenty-four children aged 3–9 yr were randomized to one of four groups to receive the following in a double-blind manner: normal saline (Group 1), remifentanil 0.75 μg kg−1 (Group 2), remifentanil 1 μg kg−1 (Group 3) and remifentanil 1.25 μg kg−1 (Group 4). Non-invasive blood pressure and heart rate were recorded before anaesthesia induction (baseline value), immediately before intubation (postinduction values), at intubation and at 1 min intervals for 5 min after intubation.


Tracheal intubation caused significant increases in systolic blood pressure and heart rate in Groups 1–3 compared with the baseline values. The maximum percent increases of systolic blood pressure and heart rate were 10% and 26% of the baseline values, respectively, in Group 2; 5% and 14% in Group 3; and 1% and 8% in Group 4 compared with 27% and 37% in Group 1. Except for the Group 3 vs. Group 4 comparison, there were significant differences among the four groups in the maximum percent increases of systolic blood pressure and heart rate.


When used as part of anaesthesia induction with propofol and vecuronium in children, bolus administration of remifentanil resulted in a dose-related attenuation of the cardiovascular intubation response.


Corresponding author

Correspondence to: Fu-shan Xue, Department of Anaesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing 100041, People’s Republic of China. E-mail:; Tel: +86 010 8870 3936; Fax: +86 010 8896 4137


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The manuscript had been presented as a Poster Discussion at the 2006 Annual Meeting of the American Society of Anaesthesiologists in Chicago, IL, USA.



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1.Xue, FS, Zhang, GH, Sun, HT et al. . A comparative study of hemodynamic responses to orotracheal intubation with fiberoptic bronchoscope and laryngoscope in children. Paediatr Anesth 2006; 16: 743747.
2.Laussen, PC, Wessel, DL. Anesthesia for congenital heart disease. In: Gregory, GA, ed. Pediatric Anesthesia, 4th edn. Philadelphia: Churchill Livingstone, 2002: 490.
3.Bissonnette, B, Dalens, B. Pediatric Anesthesia: Principles & practice. New York: McGraw-Hill Company, Inc., 2002: 786 and 1131.
4.Gupta, A, Kaur, R, Malhotra, R, Kale, S. Comparative evaluation of different doses of propofol preceded by fentanyl on intubating conditions and pressor response during tracheal intubation without muscle relaxants. Pediatr Anesth 2006; 16: 399405.
5.Hiller, A, Klemola, UM, Saarnivaara, L. Tracheal intubation after induction of anaesthesia with propofol, alfentanil and lidocaine without neuromuscular blocking drugs in children. Acta Anaesthesiol Scand 1993; 37: 725729.
6.Prakanrattana, U, Suksompong, S. Comparison of sufentanil and fentanyl for surgical repair of congenital cardiac defects. J Med Assoc Thai 2002; 85: S807S814.
7.Davis, PJ, Cladis, FP. The use of ultra-short-opioids in paediatric anaesthesia: the role of remifentanil. Clin Pharmacokinet 2005; 44: 787796.
8.Klemola, UM, Hiller, A. Tracheal intubation after induction of anesthesia in children with propofol-remifentanil or propofol-rocuronium. Can J Anesth 2000; 47: 854859.
9.Batra, YK, Al Qattan, AR, Ali, SS, Qureshi, MI, Kuriakose, D, Migahed, A. Assessment of tracheal intubating conditions in children using remifentanil and propofol without muscle relaxant. Pediatr Anesth 2004; 14: 452456.
10.Blair, JM, Hill, DA, Wilson, CM, Fee, JP. Assessment of tracheal intubation in children after induction with propofol and different doses of remifentanil. Anaesthesia 2004; 59: 2733.
11.Crawford, MW, Hayes, J, Tan, JM. Dose–response of remifentanil for tracheal intubation in infants. Anesth Analg 2005; 100: 15991604.
12.Robinson, DN, O’Brien, K, Kumar, R, Morton, NS. Tracheal intubation without neuromuscular blockade in children:a comparison of propofol combined either with alfentanil or remifentanil. Pediatr Anesth 1998; 8: 467471.
13.Xue, FS. Tracheal tube. In: Xue, FS, ed. Modern Airway Management – Critical Procedure for Anaesthesia and Intensive Care. Zhengzhou, China: Zhengzhou University Publishing House, 2002: 270272.
14.Xue, FS, Liao, X, Liu, KP et al. . The circulatory responses to tracheal intubation in children: a comparison of the oral and nasal routes. Anaesthesia 2007; 62: 220226.
15.O’Hare, R, McAtamney, D, Mirakhur, RK, Hughes, D, Carabine, U. Bolus dose remifentanil for control of haemodynamic response to tracheal intubation during rapid sequence induction of anaesthesia. Br J Anaesth 1999; 82: 283285.
16.McAtamney, D, O’Hare, R, Hughes, D, Carabine, U, Mirakhur, RK. Evaluation of remifentanil for control of haemodynamic response to tracheal intubation. Anaesthesia 1998; 53: 12231227.
17.Lentschener, C, Ghimouz, A, Bonnichon, P, Pepion, C, Gomola, A, Ozier, Y. Remifentanil-propofol vs. sufentanil-propofol: optimal combinations in clinical anaesthesia. Acta Anaesthesiol Scand 2003; 47: 8489.
18.Butterworth, JF, Bean, VE, Royster, RL. Premedication determines the circulatory responses to rapid sequence induction with sufentanil for cardiac surgery. Br J Anaesth 1989; 63: 351353.
19.Bowman, WC. Neuromuscular block. Br J Pharm 2006; 147: S277S286.
20.Trabold, F, Casetta, M, Duranteau, J et al. . Propofol and remifentanil for intubation without muscle relaxant: the effect of the order of injection. Acta Anaesthesiol Scand 2004; 48: 3539.
21.Guignard, B, Menigaux, C, Dupont, X, Fletcher, D, Chauvin, M. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg 2000; 90: 161167.
22.Wright, DR, Thornton, C, Hasan, K, Vaughan, DJ, Dore, CJ, Brunner, MD. The effect of remifentanil on the middle latency auditory evoked response and haemodynamic measurements with and without the stimulus of orotracheal intubation. Eur J Anaesthesiol 2004; 21: 509516.
23.Grant, S, Noble, S, Woods, A, Murdoch, J, Davidson, A. Assessment of intubating conditions in adults after induction with propofol and varying doses of remifentanil. Br J Anaesth 1998; 81: 540543.
24.Alexander, R, Olufolabi, AJ, Booth, J, El-Moalem, HE, Glass, PS. Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants. Anaesthesia 1999; 54: 10371040.


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Different small-dose remifentanil blunting the cardiovascular response to laryngoscopy and intubation in children: a randomized double-blind comparison

  • F. S. Xue (a1) (a2), Y. C. Xu (a1), Y. Liu (a1), Q. Y. Yang (a1), X. Liao (a1), K. P. Liu (a1), C. W. Li (a1) and H. T. Sun (a1)...


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