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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

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A Letter to the Editor to this article was published on 17 September 2018

Abstract

Purpose

Previous studies evidenced that orotracheal intubation without neuromuscular blockers is feasible in children and has some potential advantages. Remifentanil has favorable pharmacodynamic and pharmacokinetic properties as an opioid for orotracheal intubation, but its dose for excellent intubation conditions when co-administered with propofol has not been established. This study was designed to find the minimum effective dose of remifentanil for excellent intubation conditions of children when co-administered with propofol, without neuromuscular relaxant drugs.

Method

Blinded adaptive clinical trial, with sequential allocation of 27 children between 2 and 9 years-old, American Society of Anesthesiologists’ physical status PI or PII, scheduled for elective surgery under general anesthesia. Remifentanil dose began at 2 µg/kg and varied by 0.25 µg/kg according to the sequential allocation up-and-down rule designed by Dixon and Massey. Remifentanil was infused in 30 s and followed by propofol (3 mg/kg) in 20 s. Laryngoscopy and intubation were performed and assessed using Viby-Mogensen criteria, 90 s after the end of opioid administration. Inclusion of patients stopped after six crossovers, and remifentanil effective dose was estimated using pooled adjacent-violators algorithm.

Results

Remifentanil effective dose for 50% was established in 3.04 µg/kg (IC 95% 2.68–3.11, p < 0.05). The most frequent adverse effect was difficult positive pressure facial mask ventilation, which occurred in four children (15%).

Conclusion

Minimum remifentanil effective dose for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of neuromuscular blockers in children is 3.04 µg/kg.

Trial registration

NCT02454868.

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Acknowledgements

We thank Professor Nathan L. Pace, from Utah University, who gently sent us R source codes for helping us analyzing our data.

Funding

The research was carried without funding.

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Authors and Affiliations

  1. Department of Anesthesia, Hospital Universitario de Brasilia, SGAN 605 s/n, Postal Code 70.840-901, Brasilia, Distrito Federal, Brazil

    Andre Hideo Ono, Thiago Rocha Moura, Cátia Sousa Govêia, Gabriel Magalhães Nunes Guimarães, Luís Cláudio de Araújo Ladeira & Helga Bezerra Gomes da Silva

Authors
  1. Andre Hideo Ono
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  2. Thiago Rocha Moura
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  3. Cátia Sousa Govêia
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  4. Gabriel Magalhães Nunes Guimarães
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  5. Luís Cláudio de Araújo Ladeira
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  6. Helga Bezerra Gomes da Silva
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Corresponding author

Correspondence to Helga Bezerra Gomes da Silva.

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Conflict of interest

Gabriel Magalhães Nunes Guimarães received funds from Pfizer in 2017 for writing a review about COX-2 drugs. The other authors declare no significant conflicts of interest.

Disclosures

Registry name: Clinical Trials. Date the trial was registered: May, 27, 2015. Date the first participant was enrolled: July, 4, 2016. URL of the registry: https://clinicaltrials.gov/ct2/show/NCT02454868. Trial registration number: NCT02454868. Trial registration name: Remifentanil Minimum Effective Dose for Children Intubation Without Neuromuscular Blockade.

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Ono, A.H., Moura, T.R., Govêia, C.S. et al. 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 32, 493–498 (2018). https://doi.org/10.1007/s00540-018-2502-z

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  • DOI: https://doi.org/10.1007/s00540-018-2502-z

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