Sarcouncil Journal of Medical Sciences

Abstract: Background: In general, there are two major concerns about intubation and laryngoscopy when needed after induction of anesthesia in children. The first is to achieve easy endotracheal intubation by obtaining optimal intubation conditions the other concern is how to attenuate hemodynamic response to laryngoscopy and intubation. Aim of the study: Is to assess sevoflurane & remifentanil impact on pediatric patients endotracheal intubating conditions associated hemodynamic response. Patient &Method: In this randomized controlled trial, sixty children, 1-6yr old were enrolled in this study, and were divided into two groups A&B with 30 members of each. we compared intubating conditions and hemodynamic response to intubation after sevoflurane induction and the administration of intranasal remifentanil (4mcg/kg) or saline. The preinduction, pre-intubation & post intubation hemodynamic readings in children were also compared for assessing benefits of the used remifentanil as well as its safety on patients. Result: Good or excellent intubating conditions were achieved at 3 min (after IN remifentanil bolus) in 90% of the children who received intranasal remifentanil versus 3.3% in children who received placebo. There were no complications associated with the use of nasal remifentanil. HR and MAP were successfully attenuated in 90% of the study group members versus ~4% of the control group members. Unopposed upper HR &MAP readings reported in 96% of the control group members. Conclusion: Nasal administration of remifentanil one minute from sevoflurane induction of anesthesia produces optimal intubating conditions after three minutes of the administration as well as attenuation of hemodynamic response to intubation & laryngoscopy.