BJA Advance Access originally published online on March 5, 2008
British Journal of Anaesthesia 2008 100(5):717-723; doi:10.1093/bja/aen032
Different small-dose sufentanil blunting cardiovascular responses to laryngoscopy and intubation in children: a randomized, double-blind comparison
1 Department of Anaesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, People’s Republic of China
2 Xinxiang Medical College, Xinxiang, Henan, People’s Republic of China 100144
* Corresponding author. E-mail: fruitxue{at}yahoo.com.cn/ profxuefushan{at}xxmu.edu.cn
Background: Sufentanil is a potent opioid analgesic frequently used in clinical anaesthesia. This prospective, randomized, double-blind study was designed to assess the efficacy of different small-dose sufentanil attenuating the cardiovascular intubation response in healthy children, aiming at determining the optimal dose of sufentanil for this purpose.
Methods: A total of 165 children aged 3–9 yr were randomized to one of four groups to receive the following in a double-blind manner: normal saline (Group 1), sufentanil 0.1 µg kg–1 (Group 2), sufentanil 0.2 µg kg–1 (Group 3), and sufentanil 0.3 µg kg–1 (Group 4). Anaesthesia was induced with propofol 2.5 mg kg–1 and vecuronium 0.1 mg kg–1. Non-invasive blood pressure (BP) and heart rate (HR) were recorded before induction of anaesthesia (baseline value), at immediately before intubation (post-induction values), at intubation, and at 1 min intervals for 5 min after intubation. The per cent changes of systolic blood pressure (SBP) and HR during the observation were calculated.
Results: Except for Group 4, tracheal intubation caused significant increases in BP and HR in Groups 1, 2, and 3 compared with baseline values. BP and HR at intubation and their maximum values during the observation were significantly different among the four groups. The maximum per cent increases of SBP and HR during the observation were 20 and 28% of baseline values, respectively, in Group 2, 13 and 13% in Group 3, and 0 and 4% in Group 4 compared with 24 and 37% in Group 1. Except for the Group 3 vs Group 4 comparison, the incidences of SBP and HR per cent increases >30% of baseline values were also significantly different among the four groups.
Conclusions: In combination with propofol for induction of anaesthesia in children, the bolus administration of sufentanil can produce a dose-related attenuation of the cardiovascular intubation response and sufentanil 0.3 µg kg–1 can completely abolish the cardiovascular intubation response.
Keywords: anaesthetic techniques, induction; analgesics opioid, sufentanil; blood pressure, heart rate; cardiovascular system, responses; childern; laryngoscopy, intubation
The paper has been presented as a poster discussion at the 2007 Annual Meeting of the American Society of Anesthesiologists, October 13–17, 2007, in San Francisco, CA, USA.
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