IARS: Nasal Remifentanil Eases Intubation in Children

SAN DIEGO, CA — March 19, 2002 — Use of short acting, highly lipid soluble intranasal remifentanil allows intubation of children to proceed with ease, suggest results presented here on Sunday, March 17 at the 76th Clinical and Scientific Congress of the International Anesthesia Research Society (IARS).

Anesthesiologists often have to establish an airway acting alone, without an intravenous line established first for opiate delivery. Moreover, since muscle relaxants are being avoided these days, the researchers investigated whether an alternative, inhaled remifentanil, could provide adequate relaxation.

Dr. Susan Verghese of Children's National Medical Center in Washington, D.C., described the results of a study of 188 patients, ages one to seven years. Nasal remifentanil (4 mcg/kg) or saline was administered 60 seconds after induction with 8% sevoflurane and nitrous oxide.

Sevoflurane was reduced to 5% in oxygen. Laryngoscopy and intubation was attempted either two or three minutes after the nasal opioid, or saline placebo, was administered as a divided dose into each nostril.

The intubating anesthesiologist was blinded as to the nasal treatment and to the time after the treatment. A validated scoring system was used to rate the quality of intubation attempt. Factors evaluated by the scoring system included whether the vocal cords were abducted or closed, and rated airway reaction and limb movement in response to the intubation effort.

Children with asthma or reactive airway were excluded.

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