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Remifentanil And Rocuronium Withdrawal
- Prashanth Sadhahalli (19 January 2007)
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Answer to the letter 'Remifentanil for rocuronium induced pain on injection: Is this justified?'
- Hyun J. Kwak, Ji Y. Kim (8 January 2007)
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Remifentanil for Rocuronium induced pain on injection: Is this justified?
- Santhanam Suresh, Chicago, IL (4 January 2007)
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Prashanth Sadhahalli Burnley General Hospital
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Editor-I read with interest the article on pretreatment with remifentanil to prevent withdrawal after rocurunium injection in children. Pain on rocuronium injection is a well-documented fact though statistics on actual pain on injection are a bit skewed as induction agents such as propofol, which independently cause pain on injection, are administered prior to injection of muscle relaxants. In a previous study, also mentioned by Kim et al, the comparison of fentanyl v/s lidocaine for pretreatment (ahmed et al)2, showed fentanyl being more effective in preventing a withdrawal response. A similar comparison was carried out in the study by Memis et al1 , that showed the mean pain scores in the fentanyl group to be 50% higher than in the lidocaine group.Also the mean incidence of withdrawal in the lidocaine group was 26% which is comparable to that of remifentanil (23%) in the present study. Here, the comparison of remifentanil was with saline hence the statistical significance would not actually accrue into any clinical significance. A triple arm trial involving another opiate or lidocaine would have added the necessary clinical significance to the study. Prashanth Sadhahalli Burnley General Hospital, Burnley, BB10 2PQ, UK. References: 1. Dilek Memis, Alparslan Turan, Beyhan Karamanlioglu, Necdet Süt and Zafer Pamukçu : The Prevention of Pain from Injection of Rocuronium by Ondansetron, Lidocaine, Tramadol, and Fentanyl;Anesth Analg 2002;94:1517- 20 2. Norezalee Ahmad, Choy Yin Choy, Esa Ab Aris, , and Subrahmanyam Balan; Preventing the Withdrawal Response Associated with Rocuronium Injection: A Comparison of Fentanyl with Lidocaine;Anest Conflict of Interest:None declared |
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Hyun J. Kwak , Ji Y. Kim
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Local anaesthetics such as lidocaine are less expensive if the use of remifentanil was only to reduce the injection pain. However, remifentanil is also used during maintenance of anaesthesia to reduce the amount of inhalation or intravenous anaesthetics in children. It is the matter of the timing of drug injection. Besides, use of lidocaine needs time consuming venous occlusion technique. Although LMA is widely used in clinical practice, there are procedures that need secure airway such as surgeries around head and neck. Moreover, when using LMA, muscle relaxants are not needed most of the times. Conflict of Interest:None declared |
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Santhanam Suresh, Pediatric Anesthesiologist Children's Memorial Hospital, Chicago, IL
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As we move into an era of managed care and cost saving measures, the use of an expensive drug for reducing pain from injection of rocuronium seems excessive. A better comparison would have been lidocaine to remifentanil which would have given us a more objective view of 'common practice' to 'boutique practice'. Is this really a practical solution for pain on rocuronium injection and would this be universally applicable? This is a very difficult question to answer in the current medical environment we practice in. Moreover, the introduction of LMA in clinical practice has reduced the number of pediatric patients that are being intubated for surgery. Conflict of Interest:Funded research, Organon Inc |
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