Comparison of Effects of Equipotent Small-Dose Remifentanil and Fentanyl on Hemodynamic Response to Orotracheal Intubation in Children

ObjectiveTo compare the effects of equipotent small-dose remifentanil and fentanyl on hemodynamic response to orotracheal intubation in children.MethodsOne hundred children,American Society of Anesthesiologists(ASA) physical status Ⅰ or Ⅱ and scheduled for elective plastic surgery under general anesthesia,were randomly divided into 2 groups to receive the following treatments in a double blind manner:remifentanil 2 μg/kg(group R) or fentanyl 2 μg/kg(group F)(50 cases each group)when anesthesia was induced with propofol.The orotracheal intubation was performed by the direct laryngoscope.Blood pressure(BP) and heart rate(HR) were recorded before anesthesia induction(baseline values),immediately before intubation,on intubation each minute for 5 minutes after intubation.Percent changes of systolic blood pressure(SBP) and HR relative to baseline values at each observing point were calculated.The rate pressure product(RPP) at each time point was also calculated.ResultsThere were no significant differences between 2 groups in demographic data,baseline values of BP and HR and the intubation time.In group F,tracheal intubation caused significant increases in BP,HR and RPP compared with baseline values.In group R,BP,HR and RPP on intubation and their maximum values during the observation decreased significantly compared with baseline values.BP,HR and RPP at all observing points and their maximum values during the observation were significantly different between 2 groups.There were also significant differences between 2 groups in the percent changes of SBP and HR relative to baseline values at all observing points and their maximum percent changes during the observation.The incidences of SBP and HR percent increases 30% of baseline values were significantly higher in group F than those in group R,but the incidences of SBP and HR percent decreases 30% of baseline values were significantly higher in group R compared with group F.ConclusionsWhen anesthesia was induced with propofol in children,co-adminiatration of equipotent small-dose remifentanil is more effective in attenuating the hemodynamic responses to orotracheal intubation than co-adminiatration of equipotent small-dose fentanyl.Fentanyl 2 μg/kg fails to completely depress the hemodynamic response to orotracheal intubation in children.Remifentanil 2 μg/kg can completely abolish the hemodynamics response to orotracheal intubation,but may cause more adverse cardiovascular depression.