Comparative effect of remifentanil and fentanyl infusion on cerebral blood flow velocity during tracheal intubation in children undergoing sevoflurane anesthesia

摘要: Methods: With REB approval, sixty children aged 2 to 6 years, ASA I or II, undergoing surgical procedures requiring general anesthesia were randomized into one of 6 groups, to receive either a remifentanil (RF) or fentanyl (F) infusion, at a rate of 0.75, 1.0 or 1.5 μg/kg/min. Anesthesia was induced with sevoflurane in N 2 O/O 2, and maintained with 2% sevoflurane in O 2. A peripheral intravenous catheter was inserted, and a transcranial doppler (TCD) probe was placed appropriately to assess the M1 segment middle cerebral artery blood flow velocity (Vmca). Once a baseline value was recorded, the infusion was started, and Vmca values were recorded at 2 minute intervals, starting 4 minutes prior to intubation and until 4 minutes post-intubation. End tidal CO 2 values were also recorded. Demographic data is expressed as mean±SD. Differences within groups were analyzed with repeated measures ANOVA and Dunnett's test for comparison with baseline values. Analysis between groups was achieved using the Tukey test for multiple comparisons and ANOVA. The analysis of each set of TCD measurements was carried out by an investigator unaware of the drug and concentration administered. All patients were used as their own control. A P< 0.05 was accepted.Results: Sixty patients were studied. Age and weight were 4.2±1.3 yrs and 17.6±4.2 kgs, respectively. When compared to baseline, there was a significant decrease in Vmca in the RF 1.0 and RF 1.5 groups both at 4 and 2 minutes prior to tracheal intubation (P< 0.001), despite a concurrent increase in EtCO 2. A decrease in Vmca was also seen in the F1. 5 group (P< 0.001), but only at 2 …