The dose-dependent effect of remifentanil for withdrawal responses on injection of recuronium in children

BACKGROUND: The injection of rocuronium causes pain and withdrawal responses. This study was designed to determine an appropriate dose of remifentanil to prevent the withdrawal responses associated with injection of rocuronium in children. METHODS: Fourty five ASA physical status I and II pediatric patients were randomly allocated into three groups; Group I (placebo; normal saline 3 ml, n = 15), Group II (remifentanil 0.3microg/kg, n = 15), Group III (remifentanil 0.5microg/kg, n = 15). After the induction of anesthesia with 5 mg/kg of thiopental sodium, patients in groups I, II, and III received normal saline 3 ml, remifentanil 0.3microg/kg, and remifentanil 0.5microg/kg, respectively. After one minute, rocuronium 0.6 mg/kg was injected over 10 seconds. The patient's response after injection was graded using a four-point scale. The patient's heart rate (HR), mean arterial pressure (MAP) were measured at pre-anesthesia (T0), 1 minute after injection of thiopental sodium (T1), test drug (T2), and rocuronium (T3). RESULTS: The incidence of withdrawal responses was 100%, 66.7%, and 20% in groups I, II, and III, respectively. In addition, the severity of withdrawal responses was lowest in group III. CONCLUSIONS: Remifentanil 0.5microg/kg was an appropriate dose to prevent the withdrawal responses on injecting rocuronium.

Priming technique can alleviate the withdrawal responses associated with intravenous administration of rocuronium / 대한마취과학회지

BACKGROUND: Intravenous injection of rocuronium is associated with withdrawal responses which are attributable to the pain from the injection of rocuronium. Several methods have been proposed to abolish and attenuate rocuronium-induced pain. We hypothesized priming dose of rocuronium could reduce withdrawal responses associated with administering a second large dose of rocuronium for tracheal intubation. We compared the efficacy of the priming dose technique of rocuronium with intravenous lidocaine as a pre-treatment for the prevention of withdrawal responses associated with rocuronium injection. METHODS: We recruited 150 patients aged between 18 and 60 years, ASA physical status 1 or 2, who were going to undergo elective surgery requiring general anesthesia. Patients were allocated into three groups. Group C received normal saline, Group L received lidocaine 1 mg/kg, and Group P received rocuronium 0.06 mg/kg 2 minutes before administering a second large dose of rocuronium for tracheal intubation. After the loss of consciousness, rocuronium 0.6 mg/kg was administered intravenously over 10 seconds for tracheal intubation. The withdrawal responses to the injection of rocuronium were evaluated. RESULTS: The incidence of withdrawal responses associated with rocuronium injection for tracheal intubation was 56, 50, 24% in group C, group L, and group P, respectively. The incidence of withdrawal responses was lower in group P than group C and group L, but there was no difference between group L and group C. CONCLUSIONS: Priming dose technique is a useful clinical method to alleviate withdrawal responses associated with rocuronium injection.