Bolus dose remifentanil and sufentanil blunting cardiovascular intubation responses in children: a randomized, double-blind comparison

Background and objective The present randomized controlled study was designed to compare the efficacy of remifentanil 2 mu g kg(-1) and sufentanil 0.2 mu g kg(-1) by bolus injection on the cardiovascular response to intubation in healthy children. Methods One hundred and five children, ASA 1-2 and scheduled for elective plastic surgery under general anaesthesia, were randomly divided into one of two study groups to receive the following treatments in a double-blind manner: remifentanil 2 mu g kg(-1) (group R) and sufentanil 0.2 mu g kg(-1) (group S). Blood pressure and heart rate (HR) were recorded before anaesthesia induction (baseline values), immediately before intubation (postinduction values), at intubation and every minute for 5 min after intubation. The percentage changes in systolic blood pressure (SBP) and HR relative to baseline values were calculated. The incidences of SBP and HR percentage changes of more than 30% of baseline values during the observation were recorded. Results As compared with baseline values, blood pressure and HR at intubation and their maximum values during the observation increased significantly in group S, but decreased significantly in group R. Blood pressure and HR at intubation and their maximum values during the observation were significantly different between the groups. There were significant differences between the groups in the percentage changes of SBP and HR relative to baseline values and their maximum percentage changes during the observation. The incidences of SBP and HR percentage increases of more than 30% of baseline values were not significantly different between the groups, but the incidences of SBP and HR percentage decreases of more than 30% of baseline values were significantly higher in group R than in group S. Conclusion In combination with propofol for anaesthesia induction in children, sufentanil 0.2 mu g kg(-1) by bolus injection fails to depress the cardiovascular intubation response. Remifentanil 2 mu g kg(-1) by bolus injection can completely abolish the cardiovascular intubation response, but causes more adverse cardiovascular depression. Eur J Anaesthesiol 26:73-80 (c) 2009 European Society of Anaesthesiology.