The effect of age on the dose of remifentanil for tracheal intubation in infants and children

Abstract

The ED(50) of remifentanil for tracheal intubation was higher in all age groups than previously reported. Ideal intubating conditions were achieved in 50% of subjects with remifentanil doses of 3.1-3.7 mcg x kg(-1). Higher doses will be required for higher success rates and with anticholinergic pretreatment, doses of up to 6 mcg x kg(-1) were tolerated, without adverse effects, in two patients. Further investigation of the variability in dose response in infants and assessment of the safety this technique is warranted.

A Prospective Randomized Equivalence Trial of the GlideScope Cobalt® Video Laryngoscope to Traditional Direct Laryngoscopy in Neonates and Infants

“…They reported mean (SD) times of 51 (13), 32 (13) and 25 (17) s, respectively, and concluded that intubation attempts were often unsuccessful and successful attempts frequently took more than 30 s. Another trial reported mean intubation times of 10 s in neonates and infants, but intubation time was undefined in their paper, making it difficult to compare their results to ours. 23 The previous recommendation of less than 20 s for intubation time in newborns has recently been updated to 30 s by the Neonatal Resuscitation Program. 24 We compared the GlideScope Cobalt ® video laryngoscope (a curved blade) to direct laryngoscopy with a Miller blade (a straight blade) when used by practitioners who had extensive experience with both devices.…”

Sedation in the Neonatal Intensive Care Unit: International Practice

“…Based on observations in 32 "term neonates," it was documented that the effective remifentanil dose in 50 % and 98 % (ED 50 = 1.7, SD 0.1 μ[mu]g/kg, and ED 98 = 2.88, SD 0.5 μ[mu]g/kg) were similar between "neonates" (mean weight 8 kg, SD 2.2) and children [115]. However, this remifentanil dose was part of a multimodal anesthesia in combination with propofol (4 mg/kg), and glycopyrrolate (10 μ[mu] [114] Remifentanil dose-seeking study (sequential up-and-down design), including 20 neonates and young infants (0-<4 months, mean weight 5.9 kg). The ED 50 was 3.1-3.7 μ(mu)g/kg when remifentanil was coadministered with glycopyrrolate (10 μ[mu]g/kg) and propofol (5 mg/kg) g/kg) and the "neonates" were in fact infants (mean age 7 months, SD 3.3).…”

“…It achieves its peak analgesic effect within a minute of administration, 3-4 times faster when compared to fentanyl and much faster when compared to morphine. Table 15.5 provides a summary of the available studies on endotracheal intubation with remifentanil in neonates [110][111][112][113][114]. These studies do reflect the difference between the reported studies on remifentanil to facilitate endotracheal intubation in (pre)term neonates.…”

Selection of Anesthesia Techniques for the Neonate

“…Remifentanil boluses have also been evaluated as adjuvants to propofol during intravenous induction of anesthesia in infants and children [ 205 ]. Although neonates have not been studied as a group separate from infants, the ED 50 and ED 95 for remifentanil after propofol 5 mg/kg in neonates and infants <3 months of age to provide excellent intubating conditions were 3.1 and 5.0 mg/kg [ 206 ]. A continuous infusion of remifentanil has also been recommended to complement sevofl urane during induction of anesthesia.…”