Comparison of the effect of fentanyl, sufentanil, alfentanil and remifentanil on cardiovascular response to tracheal intubation in children

Laryngoscopy and tracheal intubation may cause significant cerebral and systemic hemodynamic responses. Many drugs have been shown to be effective in modifying these hemodynamic responses, including fentanyl, sufentanil, alfentanil and remifentanil. The purpose of the current study was to compare the efficacy of fentanyl, sufentanil, alfentanil and remifentanil on blunting cardiovascular changes during laryngoscopy and intubation in children. Eighty children, 1-6 years old, classified as American Society of Anesthesiologists physical status I and II who were scheduled for elective surgery with general anesthesia and orotracheal intubation, were enrolled in this randomized and double-blinded study. Patients were randomly assigned into four groups of 20 patients. Group F received fentanyl 1 micro g/kg[-1], group S received sufentanil 0.1 micro g/kg[-1], group A received alfentanil 10 micro g/kg[-1] and group Rreceived remifentanil 1 micro g/kg[-1] intravenously. After establishment of neuromuscular blockade confirmed with a nerve stimulator, laryngoscopy and orotracheal intubation were performed 3 min after induction. Hemodynamic variables including systolic and diastolic blood pressure [SAP, DAP] and heart rate [HR] were recorded at base line [before opioid administration], before laryngoscopy and one minute after orotracheal intubation. The patients' characteristics and laryngoscopy grade were similar in all groups. There was no significant difference in the mean values of SAP, DAP and HR at each measured time between the four groups. There was significant difference in the mean values of SAP, DAP and HR measured over time in each group. The intravenous fentanyl attenuated laryngoscopy-induced SAP, DAP and HR increases better than sufentanil, alfentanil or remifentanil and hemodynamic stability is better preserved with fentanyl

[Cardiovascular screening of children and parents in high-risk families]

Background: cardiovascular disease is one of the major leading cause of death in Iran. There is a strong association between parental history of cardiovascular disease clustering of risk factors in the offspring. Detection and treatment of cardiovascular risk factors since childhood is essential to reduce the incidence of disease in adulthood. This study was performed to identify major cardiovascular risk factors in middle school-aged children and their parents in high risk compared to control families

Methods: the middle schools of the 6th of Tehran were divided randomly into two groups. A total of 169 high-risk children with their families were recruited from the first group while 105 control children with their families were recruited from the second group of schools. Coronary risk factor survey was performed in the participants

Results: prevalence of increased total- and LDL-cholesterol and high FBS were higher in high-risk parents and children. Prevalence of increased BMI was higher in fathers and children of high-risk families. More fathers in high-risk families were smoker. The means of waist circumference and WHR were significantly higher in high-risk fathers. The means of total- and LDL- cholesterol were significantly higher both in parents and children of high-risk group. The means of FBS were significantly higher in fathers and offspring of high-risk families

Conclusion: cardiovascular risk factors are more prevalent and clustered in high-risk families. Screening of these families is essential to prevent progression of cardiovascular disease since childhood and reduce its burden in adulthood