• Andre Hideo Ono, Thiago Rocha Moura, Cátia Sousa Govêia, Guimarães Gabriel Magalhães Nunes GMN 0000-0001-6289-2233 Department of Anesthesia, Hospital Universitario de Brasilia, SGAN 605 s/n, Postal Code 70.8, Luís Cláudio de Araújo Ladeira, and Helga Bezerra Gomes da Silva.
• Department of Anesthesia, Hospital Universitario de Brasilia, SGAN 605 s/n, Postal Code 70.840-901, Brasilia, Distrito Federal, Brazil.
• J Anesth. 2018 Aug 1; 32 (4): 493-498.

PurposePrevious studies evidenced that orotracheal intubation without neuromuscular blockers is feasible in children and has some potential advantages. Remifentanil has favorable pharmacodynamic and pharmacokinetic properties as an opioid for orotracheal intubation, but its dose for excellent intubation conditions when co-administered with propofol has not been established. This study was designed to find the minimum effective dose of remifentanil for excellent intubation conditions of children when co-administered with propofol, without neuromuscular relaxant drugs.MethodBlinded adaptive clinical trial, with sequential allocation of 27 children between 2 and 9 years-old, American Society of Anesthesiologists' physical status PI or PII, scheduled for elective surgery under general anesthesia. Remifentanil dose began at 2 µg/kg and varied by 0.25 µg/kg according to the sequential allocation up-and-down rule designed by Dixon and Massey. Remifentanil was infused in 30 s and followed by propofol (3 mg/kg) in 20 s. Laryngoscopy and intubation were performed and assessed using Viby-Mogensen criteria, 90 s after the end of opioid administration. Inclusion of patients stopped after six crossovers, and remifentanil effective dose was estimated using pooled adjacent-violators algorithm.ResultsRemifentanil effective dose for 50% was established in 3.04 µg/kg (IC 95% 2.68-3.11, p < 0.05). The most frequent adverse effect was difficult positive pressure facial mask ventilation, which occurred in four children (15%).ConclusionMinimum remifentanil effective dose for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of neuromuscular blockers in children is 3.04 µg/kg.Trial RegistrationNCT02454868.

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