BJA Advance Access originally published online on October 14, 2004
British Journal of Anaesthesia 2005 94(1):74-79; doi:10.1093/bja/aeh293
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Haemodynamic effects of remifentanil in children with and without intravenous atropine. An echocardiographic study
1 Department of Anesthesiology and Surgical Intensive Care and 2 Department of Pediatric Dental Surgery, Pediatric and Physiology Hôpital Pontchaillou, 3 LTSI, INSERM 642 and 4 Groupe de Recherche Cardio-vasculaire (EA 3194), Université de Rennes 1, Rennes, France
* Corresponding author: Service d'Anesthésie-Réanimation Chirurgicale 2, Centre Hospitalier Regional et Universitaire, 2 rue Henri le Guilloux, 35033 Rennes Cedex 9, France. E-mail: eric.wodey{at}chu-rennes.fr
Background. Remifentanil is known to cause bradycardia and hypotension. We aimed to characterize the haemodynamic profile of remifentanil during sevoflurane anaesthesia in children with or without atropine.
Methods. Forty children who required elective surgery received inhalational induction of anaesthesia using 8% sevoflurane. They were allocated randomly to receive either atropine, 20 µg kg–1 (atropine group) or Ringer's lactate (control group) after 10 min of steady-state 1 MAC sevoflurane anaesthesia (baseline). Three minutes later (T0), all children received remifentanil 1 µg kg–1 injected over a 60 s period, followed by an infusion of 0.25 µg kg–1 min–1 for 10 min then 0.5 µg kg–1 min–1 for 10 min. Haemodynamic variables and echocardiographic data were determined at baseline, T0, T5, T10, T15 and T20 min.
Results. Remifentanil caused a significant decrease in heart rate compared with the T0 value, which was greater at T20 than T10 in the two groups: however, the values at T10 and T20 were not significantly different from baseline in the atropine group. In comparison with T0, there was a significant fall in blood pressure in the two groups. Remifentanil caused a significant decrease in the cardiac index with or without atropine. Remifentanil did not cause variation in stroke volume (SV). In both groups, a significant increase in systemic vascular resistance occurred after administration of remifentanil. Contractility decreased significantly in the two groups, but this decrease remained moderate (between –2 and +2 SD).
Conclusion. Remifentanil produced a fall in blood pressure and cardiac index, mainly as a result of a fall in heart rate. Although atropine was able to reduce the fall in heart rate, it did not completely prevent the reduction in cardiac index.
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