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BJA Advance Access published online on September 30, 2005
British Journal of Anaesthesia, doi:10.1093/bja/aei254
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted August 31, 2005

Clinical Investigation

Glycopyrrolate during sevoflurane-remifentanil-based anaesthesia for cardiac catheterization of children with congenital heart disease

K. Reyntjens 1*, L. Foubert 2, D. De Wolf 3, G. Vanlerberghe 4, and E. Mortier 1

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

* To whom correspondence should be addressed.
K. Reyntjens, E-mail: k.reyntjens{at}ugent.be


  Abstract

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.

Keywords: analgesics opioid, remifentanil; children, congenital heart disease; complications, bradycardia; procedure, cardiac catheterization.
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