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Remifentanil requirements during sevoflurane administration to block somatic and cardiovascular responses to skin incision in children and adults.
Anesthesiology. 2002 Nov; 97(5):1142-5.A

Abstract

BACKGROUND

The authors found no studies comparing intraoperative requirements of opioids between children and adults, so they determined the infusion rate of remifentanil to block somatic (IR50) and autonomic response (IRBAR50) to skin incision in children and adults.

METHODS

Forty-one adults (aged 20-60 yr) and 24 children (aged 2-10 yr) undergoing lower abdominal surgery were studied. In adults, anesthesia induction was with sevoflurane during remifentanil infusion, whereas in children remifentanil administration was started after induction with sevoflurane. After intubation, sevoflurane was administered in 100% O2 and was adjusted to an ET% of 1 MAC-awake corrected for age at least 15 min before surgery. Patients were randomized to receive remifentanil at a rate ranging from 0.05 to 0.35 microg x kg(-1) x min(-1) for at least 20 min before surgery. At the beginning of surgery, only the skin incision was performed, and the somatic and autonomic responses were observed. The somatic response was defined as positive with any gross movement of extremity, and the autonomic response was deemed positive with any increase in heart rate mean arterial pressure equal to or more than 10% of preincision values. Using logistic regression, the IR50 and IRBAR50 were determined in both groups of patients and compared with unpaired Student t test. A P value less than 0.05 was considered significant.

RESULTS

The IR50 +/- SD was 0.10 +/- 0.02 microg x kg(-1) x min(-1) in adults and 0.22 +/- 0.03 microg x kg(-1) x min(-1) in children (P < 0.001). The IRBAR50 +/- SD was 0.11 +/- 0.02 microg x kg(-1) x min(-1) in adults and 0.27 +/- 0.06 microg x kg(-1) x min(-1) in children (P < 0.001).

CONCLUSIONS

To block somatic and autonomic responses to surgery, children require a remifentanil infusion rate at least twofold higher than adults.

Authors+Show Affiliations

Department of Anesthesiology, Catholic University School of Medicine, Santiago, Chile. hmunoz@med.puc.clNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12411799

Citation

Muñoz, Hernán R., et al. "Remifentanil Requirements During Sevoflurane Administration to Block Somatic and Cardiovascular Responses to Skin Incision in Children and Adults." Anesthesiology, vol. 97, no. 5, 2002, pp. 1142-5.
Muñoz HR, Cortínez LI, Altermatt FR, et al. Remifentanil requirements during sevoflurane administration to block somatic and cardiovascular responses to skin incision in children and adults. Anesthesiology. 2002;97(5):1142-5.
Muñoz, H. R., Cortínez, L. I., Altermatt, F. R., & Dagnino, J. A. (2002). Remifentanil requirements during sevoflurane administration to block somatic and cardiovascular responses to skin incision in children and adults. Anesthesiology, 97(5), 1142-5.
Muñoz HR, et al. Remifentanil Requirements During Sevoflurane Administration to Block Somatic and Cardiovascular Responses to Skin Incision in Children and Adults. Anesthesiology. 2002;97(5):1142-5. PubMed PMID: 12411799.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Remifentanil requirements during sevoflurane administration to block somatic and cardiovascular responses to skin incision in children and adults. AU - Muñoz,Hernán R, AU - Cortínez,Luis I, AU - Altermatt,Fernando R, AU - Dagnino,Jorge A, PY - 2002/11/2/pubmed PY - 2002/11/28/medline PY - 2002/11/2/entrez SP - 1142 EP - 5 JF - Anesthesiology JO - Anesthesiology VL - 97 IS - 5 N2 - BACKGROUND: The authors found no studies comparing intraoperative requirements of opioids between children and adults, so they determined the infusion rate of remifentanil to block somatic (IR50) and autonomic response (IRBAR50) to skin incision in children and adults. METHODS: Forty-one adults (aged 20-60 yr) and 24 children (aged 2-10 yr) undergoing lower abdominal surgery were studied. In adults, anesthesia induction was with sevoflurane during remifentanil infusion, whereas in children remifentanil administration was started after induction with sevoflurane. After intubation, sevoflurane was administered in 100% O2 and was adjusted to an ET% of 1 MAC-awake corrected for age at least 15 min before surgery. Patients were randomized to receive remifentanil at a rate ranging from 0.05 to 0.35 microg x kg(-1) x min(-1) for at least 20 min before surgery. At the beginning of surgery, only the skin incision was performed, and the somatic and autonomic responses were observed. The somatic response was defined as positive with any gross movement of extremity, and the autonomic response was deemed positive with any increase in heart rate mean arterial pressure equal to or more than 10% of preincision values. Using logistic regression, the IR50 and IRBAR50 were determined in both groups of patients and compared with unpaired Student t test. A P value less than 0.05 was considered significant. RESULTS: The IR50 +/- SD was 0.10 +/- 0.02 microg x kg(-1) x min(-1) in adults and 0.22 +/- 0.03 microg x kg(-1) x min(-1) in children (P < 0.001). The IRBAR50 +/- SD was 0.11 +/- 0.02 microg x kg(-1) x min(-1) in adults and 0.27 +/- 0.06 microg x kg(-1) x min(-1) in children (P < 0.001). CONCLUSIONS: To block somatic and autonomic responses to surgery, children require a remifentanil infusion rate at least twofold higher than adults. SN - 0003-3022 UR - https://www.unboundmedicine.com/medline/citation/12411799/Remifentanil_requirements_during_sevoflurane_administration_to_block_somatic_and_cardiovascular_responses_to_skin_incision_in_children_and_adults_ L2 - https://pubs.asahq.org/anesthesiology/article-lookup/doi/10.1097/00000542-200211000-00018 DB - PRIME DP - Unbound Medicine ER -