Journal Article

Effect of remifentanil infusion rate on stress response to the pre‐bypass phase of paediatric cardiac surgery

N. K. Weale, C. A. Rogers, R. Cooper, J. Nolan and A. R. Wolf

in BJA: British Journal of Anaesthesia

Published on behalf of the British Journal of Anaesthesia

Volume 92, issue 2, pages 187-194
Published in print February 2004 | ISSN: 0007-0912
Published online February 2004 | e-ISSN: 1471-6771 | DOI: https://dx.doi.org/10.1093/bja/aeh038
Effect of remifentanil infusion rate on stress response to the pre‐bypass phase of paediatric cardiac surgery

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Background. Opioids are used routinely to eliminate the stress response in the pre‐bypass phase of paediatric cardiac surgery. Remifentanil is a unique opioid allowing a rapidly titratable effect. No data are available regarding a suitable remifentanil dose regimen for obtunding stress and cardiovascular responses to such surgery.

Methods. We recruited 49 infants and children under 5 yr old who were randomized to receive one of four remifentanil infusion rates (0.25, 1.0, 2.5, or 5.0 µg kg–1 min–1). Blood samples were obtained at induction, pre‐surgery, 5 min after opening the chest, and immediately pre‐bypass. Whole blood glucose was measured at all time points while cortisol and neuropeptide Y (NPY) were measured in the first and last samples. Heart rate and arterial pressure were also recorded.

Results. There was a significant increase in whole blood glucose 5 min after opening the chest and pre‐bypass (P=0.009, P=0.002) in patients receiving remifentanil 0.25 µg kg–1 min–1, but not in those receiving higher doses. Increased remifentanil dosage was associated with reduced plasma cortisol during surgery (P<0.001). Baseline NPY showed considerable variation and there was no association between pre‐bypass NPY and remifentanil dose. There was a significantly higher heart rate at the pre‐bypass stage of surgery in the remifentanil 0.25 µg kg–1 min–1 group compared with higher doses (P=0.0006). Four out of five neonates with complex cardiac conditions showed severe bradycardia associated with remifentanil.

Conclusions. In infants and children under 5 yr, remifentanil infusions of 1.0 µg kg–1 min–1 and greater can suppress the glucose increase and tachycardia associated with the pre‐bypass phase of cardiac surgery, while 0.25 µg kg–1 min–1 does not. Remifentanil should be used with caution in neonates with complex congenital heart disease.

Br J Anaesth 2004; 92: 187–94

Keywords: anaesthesia, paediatric; analgesics opioid, remifentanil; complications, congenital heart disease; protein, neuropeptide Y; stress, response

Journal Article.  4285 words.  Illustrated.

Subjects: Anaesthetics

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