The Effect of Intranasal Administration of Remifentanil on Intubating Conditions and Airway Response After Sevoflurane Induction of Anesthesia in Children

• Published in: Anesthesia and analgesia Vol. 107; no. 4; pp. 1176 - 1181
• Main Authors: VERGHESE, Susan T, HANNALLAH, Raafat S, BRENNAN, Marjorie, YARVITZ, Jessica L, HUMMER, Kelly A, PATEL, Kantilal M, HE, Jainping, MCCARTER, Robert
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.10.2008
• Subjects: Adjuvants, Anesthesia - administration & dosage; Adjuvants, Anesthesia - pharmacokinetics; Administration, Intranasal; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - pharmacokinetics; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Inhalation; Anesthetics, Intravenous; Biological and medical sciences; Child; Child, Preschool; Double-Blind Method; Elective Surgical Procedures; Female; Humans; Infant; Intubation, Gastrointestinal; Laryngoscopy; Male; Medical sciences; Methyl Ethers; Piperidines - administration & dosage; Piperidines - pharmacokinetics; Volatile compound; Human; Agonist; μ Opioid receptor; Opiates; Intranasal administration; Narcotic analgesic; Remifentanil; Sevoflurane; General anesthetic; Anesthesia; Phenylpiperidine derivatives; Sedative; Child; Halogen Organic compounds
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/ane.0b013e3181838e95

Intubation without the use of muscle relaxants in children is frequently done before IV access is secured. In this randomized controlled trial, we compared intubating conditions and airway response to intubation (coughing and/or movement) after sevoflurane induction in children at 2 and 3 min after the administration of intranasal remifentanil (4 mcg/kg) or saline. One hundred eighty-eight children, 1-7-yr old, were studied. Nasal remifentanil (4 mcg/kg) or saline was administered 1 min after an 8% sevoflurane N2O induction. The sevoflurane concentration was then reduced to 5% in oxygen, and ventilation assisted/controlled. An anesthesiologist blinded to treatment assignment used a validated score to evaluate the conditions for laryngoscopy and response to intubation. Blood samples for determination of remifentanil blood concentrations were collected from 17 children at baseline, 2, 3, 4, and 10 min after nasal administration of remifentanil. Good or excellent intubating conditions were achieved at 2 min (after the remifentanil bolus) in 68.2% and at 3 min in 91.7% of the children who received intranasal remifentanil versus 37% and 23% in children who received placebo (P<0.01). The mean remifentanil plasma concentrations (+/-sd) at 2, 3, 4, and 10 min were 1.0 (0.60), 1.47 (0.52), 1.70 (0.46), and 1.16 (0.36) ng/mL, respectively. Peak plasma concentration was observed at 3.47 min. There were no complications associated with the use of nasal remifentanil. Nasal administration of remifentanil produces good-to-excellent intubating conditions in 2-3 min after sevoflurane induction of anesthesia.