Prevention of Rocuronium-induced Withdrawal Movement in Children: A Comparison of Remifentanil with Lidocaine

Abstract

Background : This randomized, double-blind study was designed to compare the efficacy of remifentanil and lidocaine with the venous occlusion technique for preventing the withdrawal response associated with rocuronium injection in children.

Methods : Ninety children between 3 and 10 years of age were randomly allocated into 1 of 3 groups that were intravenously administered either 1?g/kg of remifentanil (remifentanil group), 1 mg/kg of lidocaine (lidocaine group) or 5 ml of saline (control group). After general anesthesia was induced with 5 mg/kg of 2.5% thiopental sodium, manual occlusion of venous outflow was performed, and the test drug was then injected over 30 sec. In addition, when manual forearm pressure was released, 0.6 mg/kg of 1% rocuronium was injected over 5 sec and the response was then recorded. Additionally, the mean arterial pressure (MAP) and heart rate (HR) were recorded upon arrival in the operating theatre, as well as 1 minute before and 1 min after tracheal intubation.

Results : The incidences of withdrawal movement and generalized movement in the control group were significantly higher than in the remifentanil and lidocaine groups. In addition, the MAP and HR were significantly lower in the remifentanil group than the control and lidocaine groups after tracheal intubation.

Conclusion : In children, treatment with either 1?g/kg of remifentanil or 1 mg/kg of lidocaine decreased the incidence of rocuronium-induced withdrawal movements. However, remifentanil was more effective than lidocaine at controlling hemodynamics following tracheal intubation.