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BJA Advance Access originally published online on October 25, 2006
British Journal of Anaesthesia 2007 98(1):120-123; doi:10.1093/bja/ael285
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Pretreatment with remifentanil to prevent withdrawal after rocuronium in children

J. Y. Kim1, J. Y. Kim2, Y. B. Kim2 and H. J. Kwak2,*

1 Department of Anaesthesiology and Pain Medicine, Ajou University College of Medicine Suwon, Korea
2 Department of Anaesthesiology and Pain Medicine, Gachon University of Medicine and Science Gil Medical Center Incheon, Korea

*Corresponding author: Department of Anaesthesiology and Pain Medicine, Gachon University of Medicine and Science Gil Medical Center, 1198 Guwol-dong, Namdong-gu, Incheon 405-760, Korea. E-mail: hyun615{at}gilhospital.com

Background. Pain from rocuronium injection is a common side-effect reported to occur in 50–80% of the patients. This randomized, double-blind, placebo-controlled study was designed to evaluate the efficacy of pretreatment with i.v. remifentanil on prevention of withdrawal response during rocuronium injection in paediatric patients.

Methods. After obtaining parental consents, 70 paediatric patients were randomly allocated into two groups to receive either i.v. remifentanil 1 µg kg–1 (remifentanil group, n=35) or i.v. saline 5 ml (saline group, n=35). Anaesthesia was induced with thiopental sodium 2.5% (5 mg kg–1) and the test drug was injected over 30 s. One minute after the test drug injection, rocuronium 1% (0.6 mg kg–1) was injected over 5 s and the response was recorded. Mean arterial pressure (MAP) and heart rate were recorded on arrival in the operating theatre, before and 1 min after the tracheal intubation.

Results. The overall incidence of withdrawal movements was significantly higher in the saline group (33 patients; 94%) than that in the remifentanil group (8 patients; 23%) (P<0.001). No patient in the remifentanil group showed generalized movement, whereas 51% of patients in the saline group did. Remifentanil prevented significant increase in MAP after intubation.

Conclusion. This study demonstrated that pretreatment with remifentanil 1 µg kg–1 provided a safe and simple method for reducing the incidence of rocuronium-associated withdrawal movement with haemodynamic stability in children.


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E-letters:

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Remifentanil for Rocuronium induced pain on injection: Is this justified?
Santhanam Suresh, et al.
British Journal of Anaesthesia, 4 Jan 2007 [Full text]
Answer to the letter 'Remifentanil for rocuronium induced pain on injection: Is this justified?'
Hyun J. Kwak, et al.
British Journal of Anaesthesia, 8 Jan 2007 [Full text]
Remifentanil And Rocuronium Withdrawal
Prashanth Sadhahalli
British Journal of Anaesthesia, 19 Jan 2007 [Full text]

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