BJA Advance Access originally published online on September 30, 2005
British Journal of Anaesthesia 2005 95(5):680-684; doi:10.1093/bja/aei254
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Glycopyrrolate during sevoflurane–remifentanil-based anaesthesia for cardiac catheterization of children with congenital heart disease
1 Department of Anaesthesiology, University Hospital Ghent, Ghent, Belgium. 2 Department of Anaesthesiology and CCM, OLV Hospital, Aalst, Belgium. 3 Department of Paediatric Cardiology, University Hospital Ghent, Ghent, Belgium. 4 Department of Anaesthesiology, H.H.R.M. Hospital, Menen, Belgium
* Corresponding author. E-mail: k.reyntjens{at}ugent.be
Background. Remifentanil is recommended for use in procedures with painful intraoperative stimuli but minimal postoperative pain. However, bradycardia and hypotension are known side-effects. We evaluated haemodynamic effects of i.v. glycopyrrolate during remifentanil–sevoflurane anaesthesia for cardiac catheterization of children with congenital heart disease.
Methods. Forty-five children undergoing general anaesthesia with remifentanil and sevoflurane were randomly allocated to receive either saline, glycopyrrolate 6 µg kg–1 or glycopyrrolate 12 µg kg–1. After induction of anaesthesia with sevoflurane, i.v. placebo or glycopyrrolate was administered. An infusion of remifentanil at the rate of 0.15 µg kg–1min–1 was started, sevoflurane continued at 0.6 MAC and cisatracurium 0.2 mg kg–1 was given. Heart rate (HR) and non-invasive arterial pressures were monitored and noted every minute for the first 10 min and then every 2.5 min for subsequent maximum of 45 min.
Results. Baseline HR [mean (SD)] of 117 (20) beats min–1 decreased significantly from 12.5 min onwards after starting the remifentanil infusion in the control group [106 (18) at 12.5 min and 99 (16) beats min–1 at 45 min]. In the groups receiving glycopyrrolate, no significant decrease in HR was noticed. Glycopyrrolate at 12 µg kg–1 induced tachycardia between 5 and 9 min after administration. Systolic and diastolic arterial pressures decreased gradually, but there were no significant differences in the pressures between groups.
Conclusion. I.V. glycopyrrolate 6 µg kg–1 prevents bradycardia during general anaesthesia with remifentanil and sevoflurane for cardiac catheterization in children with congenital heart disease. Administering 12 µg kg–1 of glycopyrrolate temporarily induces tachycardia and offers no additional advantage.
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  M. Zaballos, C. Jimeno, J. Almendral, F. Atienza, D. Patino, E. Valdes, J. Navia, and M. J. Anadon Cardiac electrophysiological effects of remifentanil: study in a closed-chest porcine model Br. J. Anaesth., August 1, 2009; 103(2): 191 - 198. [Abstract] [Full Text] [PDF]
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