Effect of Remifentanil on Tracheal Intubation Conditions and Haemodynamics in Children Anaesthetised with Sevoflurane and Nitrous Oxide

This study examined the effect of remifentanil added to inhalation agents on intubating conditions in children (aged one to seven years). As is our routine, all patients were premedicated with 0.004 mg/kg glycopyrrolate intramuscularly 30 minutes before anaesthesia to prevent bradycardia and salivary secretion, and received intravenous 1 mg/kg ketamine prior to transfer into the operating room to facilitate separation of the child from the parents. Laryngoscopy was attempted after ventilation with 8% sevoflurane in 50% nitrous oxide and 50% oxygen for two minutes, and intravenous administration of either a placebo bolus of saline (Group S) or one of two doses of remifentanil, 1 μg/kg (Group R1) or 2 μg/kg (Group R2) given over 30 seconds, commenced at the beginning of the sevoflurane administration. Only 18 of 32 patients (56.3%) in Group S had acceptable intubating conditions compared with 31 of 32 patients (96.9%) in Group R1 and 32 of 32 patients (100%) in Group R2 (P <0.001). Mean blood pressure was lower in Group R1 and R2 compared with Group S (P <0.005). Our routine use of ketamine and glycopyrrolate may have influenced the relative lack of significant hypotension and bradycardia. Sevoflurane, nitrous oxide and remifentanil provided acceptable conditions for tracheal intubation in children and could be an acceptable alternative to intravenous induction and neuromuscular blocking agents.