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Updated: Mar 12, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Pharmacological agents for reducing the haemodynamic response to tracheal intubation in paediatric patients: a
1Senior Instructor, Anaesthesia, Aga Khan University, Karachi, Sindh, Pakistan.
Insights
Pharmacological agents, particularly opioids like fentanyl and remifentanil, can safely blunt the hemodynamic response to tracheal intubation in children. Careful dosing is recommended to avoid hypotension and monitor for rare side effects.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Pharmacology
Background:
- Tracheal intubation can cause significant hemodynamic responses in pediatric patients.
- Managing these responses is crucial for patient safety during surgery.
- Pharmacological agents are often used to attenuate these effects.
Purpose of the Study:
- To review the efficacy of pharmacological agents in blunting the hemodynamic response to tracheal intubation in pediatric patients.
- To identify adverse effects associated with these agents.
- To assess the role of these agents in reducing arrhythmias.
Main Methods:
- Systematic literature search of PubMed, CINAHL, and Cochrane databases (1980-2014).
- Inclusion of randomized controlled trials evaluating pharmacological agents' effects on hemodynamic response to intubation.
- Outcome measures included blood pressure, heart rate, adverse effects, and arrhythmias.
Main Results:
- Sixteen studies involving 1408 children were analyzed.
- Opioids, including fentanyl, remifentanil, sufentanil, and alfentanil, demonstrated dose-dependent blunting of the hemodynamic response.
- Higher doses of remifentanil and sufentanil were most effective but risked hypotension; side effects and arrhythmias were infrequent.
Conclusions:
- Specific opioid doses (e.g., fentanyl 2 µg/kg, remifentanil 1 µg/kg) can safely attenuate the hemodynamic response to tracheal intubation in pediatric patients.
- Close monitoring for rare side effects is advised when using these agents.
- The identified safe and effective doses provide guidance for clinical practice.
Abstract:
The primary aim of this review was to assess the effect of pharmacological agents administered to attenuate the haemodynamic response to tracheal intubation in paediatric patients up to 16 years of age undergoing elective surgery. Secondary aims were to identify adverse effects related to these agents, and the agents' roles in decreasing arrhythmias. A systematic search was conducted for articles listed in PubMed, CINAHL or the Cochrane database between January 1980 and June 2014. We included randomised controlled trials where the stated aim of the study included observing the effects of pharmacological agents on the haemodynamic response to tracheal intubation. The outcome measures were changes in mean, systolic and diastolic blood pressure and heart rate, adverse effects of drugs and arrhythmias. Sixteen publications with a total of 1408 children (ages two to 15 years) were identified. These studies varied in methodology and quality. Opioids were the commonest agents used and appeared to obtund the response in a dose-related manner. Fentanyl 2 µg/kg, remifentanil 1 µg/kg, sufentanil 0.1 and 0.2 µg/kg and alfentanil 25 µg/kg blunted the haemodynamic response. Remifentanil 3 µg/kg and sufentanil 0.3 µg/kg were the most effective in obliterating the response but led to hypotension in unstimulated patients. Opioid-related side-effects and arrhythmias were observed in few patients. We recommend that when required, the safe and effective doses identified in this review be used to obtund the haemodynamic response to intubation in paediatric patients, with close observation for the uncommon but recognised side-effects.
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