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Remifentanil requirements during propofol administration to block the somatic response to skin incision in children and adults.
Anesth Analg. 2007 Jan; 104(1):77-80.A&A

Abstract

BACKGROUND

During sevoflurane administration, children require a remifentanil infusion rate twofold higher than adults to block responses to skin incision. Similar data concerning remifentanil requirements are unavailable during total IV anesthesia.

METHODS

We prospectively determined the infusion rate (IR) of remifentanil necessary to block the somatic response to skin incision in 50% (IR50) of adults (n = 20, aged 20-60 yr) and children (n = 20, aged 3-11 yr) during propofol anesthesia. In each patient undergoing lower abdominal surgery, a remifentanil infusion was initiated, followed by target-controlled infusion of propofol set at a plasma concentration of 6 mug/mL. After tracheal intubation, propofol was reduced to 3 microg/mL until the end of the study. Remifentanil IR was determined according to Dixon's up-and-down method, with the first patient in each group receiving 0.2 microg x kg(-1) x min(-1) followed by the consecutive patient receiving 0.02 microg x kg(-1) x min(-1) modifications according to the response of the previous patient. The remifentanil IR was kept unchanged for at least 20 min before surgery. At the beginning of surgery, only the skin incision was performed, and the somatic response was observed. If there was any gross movement of extremity the response was considered positive.

RESULTS

The IR50 (CI(95%)) was 0.08 (0.06-0.12) microg x kg(-1) x min(-1) in adults and 0.15 (0.13-0.17) microg x kg(-1) x min(-1) in children (P < 0.001).

CONCLUSION

These results demonstrate that, similar to sevoflurane anesthesia, during total IV anesthesia with propofol, children require a remifentanil IR almost twofold higher than adults to block the somatic response to skin incision.

Authors+Show Affiliations

Departamento de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. hmunoz@med.puc.clNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17179247

Citation

Muñoz, Hernán R., et al. "Remifentanil Requirements During Propofol Administration to Block the Somatic Response to Skin Incision in Children and Adults." Anesthesia and Analgesia, vol. 104, no. 1, 2007, pp. 77-80.
Muñoz HR, Cortínez LI, Ibacache ME, et al. Remifentanil requirements during propofol administration to block the somatic response to skin incision in children and adults. Anesth Analg. 2007;104(1):77-80.
Muñoz, H. R., Cortínez, L. I., Ibacache, M. E., & Altermatt, F. R. (2007). Remifentanil requirements during propofol administration to block the somatic response to skin incision in children and adults. Anesthesia and Analgesia, 104(1), 77-80.
Muñoz HR, et al. Remifentanil Requirements During Propofol Administration to Block the Somatic Response to Skin Incision in Children and Adults. Anesth Analg. 2007;104(1):77-80. PubMed PMID: 17179247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Remifentanil requirements during propofol administration to block the somatic response to skin incision in children and adults. AU - Muñoz,Hernán R, AU - Cortínez,Luis I, AU - Ibacache,Mauricio E, AU - Altermatt,Fernando R, PY - 2006/12/21/pubmed PY - 2007/1/24/medline PY - 2006/12/21/entrez SP - 77 EP - 80 JF - Anesthesia and analgesia JO - Anesth Analg VL - 104 IS - 1 N2 - BACKGROUND: During sevoflurane administration, children require a remifentanil infusion rate twofold higher than adults to block responses to skin incision. Similar data concerning remifentanil requirements are unavailable during total IV anesthesia. METHODS: We prospectively determined the infusion rate (IR) of remifentanil necessary to block the somatic response to skin incision in 50% (IR50) of adults (n = 20, aged 20-60 yr) and children (n = 20, aged 3-11 yr) during propofol anesthesia. In each patient undergoing lower abdominal surgery, a remifentanil infusion was initiated, followed by target-controlled infusion of propofol set at a plasma concentration of 6 mug/mL. After tracheal intubation, propofol was reduced to 3 microg/mL until the end of the study. Remifentanil IR was determined according to Dixon's up-and-down method, with the first patient in each group receiving 0.2 microg x kg(-1) x min(-1) followed by the consecutive patient receiving 0.02 microg x kg(-1) x min(-1) modifications according to the response of the previous patient. The remifentanil IR was kept unchanged for at least 20 min before surgery. At the beginning of surgery, only the skin incision was performed, and the somatic response was observed. If there was any gross movement of extremity the response was considered positive. RESULTS: The IR50 (CI(95%)) was 0.08 (0.06-0.12) microg x kg(-1) x min(-1) in adults and 0.15 (0.13-0.17) microg x kg(-1) x min(-1) in children (P < 0.001). CONCLUSION: These results demonstrate that, similar to sevoflurane anesthesia, during total IV anesthesia with propofol, children require a remifentanil IR almost twofold higher than adults to block the somatic response to skin incision. SN - 1526-7598 UR - https://www.unboundmedicine.com/medline/citation/17179247/Remifentanil_requirements_during_propofol_administration_to_block_the_somatic_response_to_skin_incision_in_children_and_adults_ L2 - https://doi.org/10.1213/01.ane.0000251201.81210.e7 DB - PRIME DP - Unbound Medicine ER -