Related Experiment Video

Updated: Jun 26, 2026

Guidelines for Elective Pediatric Fiberoptic Intubation
11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

Bolus dose remifentanil and sufentanil blunting cardiovascular intubation responses in children: a randomized,

Xu Liao1, Quan-Yong Yang, Fu-Shan Xue

  • 1Department of Anaesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, PR China.

European Journal of Anaesthesiology
|January 6, 2009
PubMed

Insights

Remifentanil 2 mcg/kg abolished cardiovascular responses to intubation in children but caused more depression. Sufentanil 0.2 mcg/kg did not fully blunt these responses, showing less adverse cardiovascular effects.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Cardiovascular Pharmacology

Background:

  • Cardiovascular responses to tracheal intubation can be significant in children.
  • Opioid analgesics are commonly used to attenuate these responses during general anesthesia.

Purpose of the Study:

  • To compare the efficacy of remifentanil and sufentanil in blunting the cardiovascular response to intubation in healthy pediatric patients.
  • To evaluate the incidence of adverse cardiovascular events associated with each agent.

Main Methods:

  • A randomized, double-blind study involving 105 children (ASA 1-2) undergoing elective surgery.
  • Children received either remifentanil 2 mcg/kg (Group R) or sufentanil 0.2 mcg/kg (Group S) as a bolus.
  • Blood pressure and heart rate were monitored from baseline through 5 minutes post-intubation.

Main Results:

  • Remifentanil significantly decreased blood pressure and heart rate, while sufentanil caused significant increases compared to baseline.
  • Both agents differed significantly in their effects on blood pressure and heart rate at intubation and peak changes.
  • While increases in blood pressure/heart rate were similar, significant decreases (>30%) were more frequent with remifentanil.

Conclusions:

  • Sufentanil 0.2 mcg/kg does not fully suppress the cardiovascular response to intubation in children when used with propofol.
  • Remifentanil 2 mcg/kg effectively abolishes the intubation response but is associated with greater cardiovascular depression.
Abstract

Related Concept Videos

Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
Drug Delivery: Enteral Route01:18

Drug Delivery: Enteral Route

The enteral drug administration involves three primary routes: oral, sublingual, and buccal. Oral ingestion is the most prevalent, safe, economical, and convenient method for drug administration. However, it has certain drawbacks, including limited absorption due to the drug's low water solubility or poor membrane permeability, possible emesis from GI mucosa irritation, destruction of drugs by digestive enzymes or low gastric pH, and irregular absorption along with food or other drugs.
Drugs in...
Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence01:22

Pharmaceutical Alternatives: Stability-Related Therapeutic Nonequivalence

Generic intravenous (IV) drugs are considered bioequivalent to their branded counterparts due to their 100% bioavailability upon administration. However, variations in stability among different drug products can significantly influence their therapeutic performance, even if they are pharmaceutically equivalent.Cefuroxime, a prophylactic antimicrobial, is often used as a single-dose IV injection for patients undergoing coronary artery bypass grafting surgery. A 3 g dose typically provides...