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Canadian Journal of Anesthesia 49:1070-1075 (2002)
© Canadian Anesthesiologists' Society, 2002
Obstetrical and Pediatric Anesthesia

Fentanyl is more effective than remifentanil at preventing increases in cerebral blood flow velocity during intubation in children

[Le fentanyl est plus efficace que le rémifentanil à prévenir des augmentations de la vitesse circulatoire cérébrale pendant l’intubation chez les enfants]

Claude Abdallah, MD FRCPC, Cengiz Karsli, BSc MD FRCPC and Bruno Bissonnette, BSc MD FRCPC

From the Department of Anaesthesia, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. B. Bissonnette, Department of Anaesthesia, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Phone: 416-813-7445, Fax: 416-813-7543; E-mail: bruno{at}anaes.sickkids.on.ca

Purpose: Controlling the cerebral and systemic hemodynamic responses to laryngoscopy and tracheal intubation may play a role in determining clinical outcome in pediatric neurosurgical patients. This study compared the effects of remifentanil and fentanyl on cerebral blood flow velocity (CBFV) and hemodynamic profile during laryngoscopy and tracheal intubation in children under sevoflurane anesthesia.

Methods: Sixty healthy children aged two to six years undergoing dental surgery under general anesthesia were enrolled. Each child was randomly assigned to receive a remifentanil or fentanyl infusion, at a rate of 0.75, 1.0, or 1.5 µg•kg-1•min-1 after induction of anesthesia with 2% sevoflurane. Middle cerebral artery blood flow velocity was measured by transcranial Doppler (TCD) sonography. Once a baseline set of hemodynamic variables and TCD measurements were recorded, the opioid infusion was started. Measurements were taken at two-minute intervals, starting four minutes prior to laryngoscopy until four minutes following naso-tracheal intubation.

Results: Remifentanil caused a more significant decrease in mean arterial pressure and CBFV prior to tracheal intubation than did fentanyl (P < 0.001). During laryngoscopy and for two minutes following tracheal intubation, CBFV increased in all remifentanil groups (P < 0.05), whereas it remained stable in all fentanyl groups.

Conclusion: This study suggests that fentanyl was more effective than remifentanil at preventing increases in CBFV during and immediately following laryngoscopy and tracheal intubation in children undergoing sevoflurane anesthesia. Fentanyl also seemed to provide a more stable hemodynamic profile prior to laryngoscopy and tracheal intubation when compared to remifentanil.




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Anesth. Analg., October 1, 2004; 99(4): 1193 - 1198.
[Abstract] [Full Text] [PDF]


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