The Effects of Remifentanil to Prevent the Hemodynamic Changes to Mouth Gag Insertion in Tonsillectomy

ABSTRACT

BACKGROUND: The insertion of a mouth gag causes acute hemodynamic changes such as hypertension and tachycardia. Several adjuvant drugs have been used to attenuate such responses. The aim of this study was to determine the effects of remifentanil in preventing the hemodynamic changes associated with the insertion of mouth gag after a remifentanil injection. METHODS: Thirty children, ASA1 or 2, who were scheduled for elective surgery, were divided randomly into two groups; group I (placebo; normal saline 0.05 ml/kg, n = 15), and group II (remifentanil 0.05microg/kg, n = 15). After inducing general anesthesia with thiopental sodium (5 mg/kg) and rocuronium (0.06 mg/kg), anesthesia was maintained by the inhalation of sevoflurane 2 vol% in N2O/O2 (50/50) via an endotracheal tube. The patients in group I and II received normal saline 0.05 ml/kg, and remifentanil 0.05microg/kg 1 minute before inserting the mouth gag, respectively. The patients' blood pressure heart rate were measured before and after inserting mouth gag. RESULTS: The hemodynamic changes in group I were minimal after inserting the mouth gag compared with group II. CONCLUSIONS: Remifentanil is effective in attenuating the increase in blood pressure and heart rate after inserting a mouth gag.