A dose study of remifentanil in combination with propofol during tracheobronchial foreign body removal in children

Abstract

Study Objective: To assess the effect of two different remifentanil infusion doses on hemodynamic stability and recovery characteristics in children undergoing tracheobronchial foreign body removal during rigid bronchoscopy. Design: Prospective, randomized, clinical comparison study. Setting: Operating room of a university hospital. Patients: 70 ASA physical status 1 and 2 children, aged 3-12 years, presenting for tracheobronchial foreign body removal during rigid bronchoscopy. Interventions: Children were divided equally into two groups to receive either a 0.1 mu g/kg/min (Group R1) or 0.2 mu g/kg/min (Group R2) remifentanil infusion. Ten minutes after the remifentanil infusion, 3 mg/kg of propofol and 0.02 mg/kg of atropine were given. Anesthesia was maintained with 0.1 mu g/kg/min of remifentanil and 100-250 mu g/kg/min of propofol in Group R1 and 02 mu g/kg/min of remifentanil and 100-250 mu g/kg/min of propofol in Group R2. After baseline measurements were recorded, 0.2 mg/kg of mivacurium was given intravenously. Ventilation was maintained with 100% O-2 via a "T" piece connected to the side arm of the bronchoscope. Measurements: Heart rate (HR), systolic (SBP), diastolic (DBP) and mean arterial pressures (MAP), and O-2 saturation (SpO(2)) were recorded before (baseline) and after induction, and 1, 3, 5, 10, 15, 20, 25, and 30 minutes after insertion of the rigid bronchoscope into the trachea. Emergence characteristics and complications were noted. Statistical analysis was performed using independent samples t-test, repeated measures, and chi-square test as appropriate. Main Results: Groups were similar in demographics and duration of bronchoscopy and anesthesia (P>0.05). In Group R1, HR, SBP, DBP, and MAP increased one minute after insertion of the bronchoscope in Group R1 (P<0.01). Propofol consumption was significantly higher in Group R1 (63.6 +/- 30.1 mg) than Group R2 (39.8 +/- 26.6 mg; P<0.01). Time to spontaneous eye opening was 8.6 +/- 1.3 minutes in Group R1 and 6.3 +/- 1.1 minutes in Group R2 (P<0.05). The time to recovery to an Aldrete score of 9 was greater in Group R1 (19.8 +/- 3.0 min) than Group R2 (16.1 +/- 3.0 min; P<0.01). Conclusion: A remifentanil 0.2 mu g/kg/min infusion with propofol provides hemodynamic stability and early recovery in children undergoing foreign body removal during rigid bronchoscopy. (C) 2013 Elsevier Inc. All rights reserved.