Journal of Anesthesia

, Volume 32, Issue 6, pp 916–916 | Cite as

Effective dose of remifentanil for intubation in children

  • Liu-Jia-Zi Shao
  • Fu-Shan XueEmail author
  • Rui-Juan Guo
Letter to the Editor


Remifentanil Tracheal intubation Children 

To the Editor:

In recent article of Ono et al. [1] determining minimum effective dose of remifentanil for excellent intubation conditions in children when co-administered with propofol without muscle relaxants, intubation conditions as main endpoints were assessed by Viby-Mogensen criteria [2]. However, Viby-Mogensen criteria were originally designed to qualitatively assess the intubation conditions when combined anesthetic induction drugs with muscle relaxants. Furthermore, Viby-Mogensen criteria are consisted of variables assessing laryngoscopy conditions, position and movements of vocal cords, and reactions to tracheal intubation. By combining three-part parameters of different natures, a final score for intubation conditions is provided. As vocal cords are often closed when combined propofol with opioid drugs without muscle relaxants, we argue that use of Viby-Mogensen criteria including variables of vocal cords may underestimate intubation conditions.

Difficult facemask ventilation was defined by the American Society of Anesthesiologists’ criteria and occurred in 15% of children. However, a limitation of the American Society of Anesthesiologists’ criteria is inability to provide severity of difficult facemask ventilation, though it is important for safe airway management. Thus, Han scale is often used when quantitatively assessing effectiveness of facemask ventilation during anesthesia induction [3].


Compliance with ethical standards

Conflict of interest

All authors have no financial support and potential conflicts of interest for this work.


  1. 1.
    Ono AH, Moura TR, Govêia CS, Guimarães GMN, de Araújo Ladeira LC, da Silva HBG. ED50 of remifentanil for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of muscle relaxants in children: dose-finding clinical trial. J Anesth. 2018;32:493–8.CrossRefGoogle Scholar
  2. 2.
    Helbo-Hansen S, Ravlo O, Trap-Anderson S. The influence of alfentanil on the intubating condition after priming with vecuronium. Acta Anaesthesiol Scand. 1988;32:41–4.CrossRefGoogle Scholar
  3. 3.
    Han R, Tremper KK, Kheterpal S, O’Reilly M. Grading scale for mask ventilation. Anesthesiology. 2004;101:267.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology, Beijing Friendship HospitalCapital Medical UniversityBeijingPeople’s Republic of China

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