Related Experiment Videos
Spontaneous ventilation with remifentanil in children
J Mark Ansermino1, Peter Brooks, David Rosen
1Department of Anesthesia, British Columbia Children's Hospital, University of British Columbia, BC, Canada. anserminos@yahoo.ca
Paediatric Anaesthesia
|January 29, 2005
Summary
The maximum tolerated dose of remifentanil varies significantly in children undergoing anesthesia. A respiratory rate below 10 breaths per minute is the best indicator of the maximum dose a child can tolerate.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
Background:
- Remifentanil, a potent opioid analgesic, is valuable for studying respiratory effects due to its short duration of action.
- Understanding remifentanil's effects during spontaneous ventilation in children is crucial for safe clinical practice.
- Pharmacokinetic data alone is insufficient for developing pediatric infusion guidelines.
Purpose of the Study:
- To determine the effects of remifentanil infusion on spontaneous ventilation in pediatric patients.
- To establish guidelines for remifentanil administration in children undergoing dental procedures.
Main Methods:
- 32 children (aged 2-7 years) undergoing restorative dentistry were studied.
- Remifentanil infusion was administered incrementally after an initial bolus dose.
- Infusion increments were stopped based on predefined respiratory parameters (end-tidal CO2, SpO2, apnea).
Main Results:
- The median maximum tolerated dose of remifentanil was 0.127 microg.kg(-1).min(-1).
- Significant changes in respiratory rate (35%) occurred in the final 10 minutes of incremental increases.
- Changes in end-tidal carbon dioxide and minute ventilation were gradual and less pronounced.
Conclusions:
- There is substantial inter-individual variability in remifentanil tolerance among children.
- A respiratory rate below 10 breaths per minute is a reliable predictor of the maximum tolerated remifentanil dose.
- These findings aid in optimizing remifentanil use in pediatric anesthesia.