Original Article

Remifentanil to Facilitate High-Resolution Computed Tomography Imaging of the Chest or Magnetic Resonance Imaging in Infants

Authors: Gayatri Joshi MD, Joseph D. Tobias MD

Abstract

Introduction:High-resolution computed tomography (CT) imaging or magnetic resonance (MR) imaging may require brief periods of apnea for image acquisition. In adults, this may be done by voluntary breath holding. In infants and children, such studies are generally performed under general anesthesia using a laryngeal mask airway with maintenance of spontaneous ventilation.Methods:We report a technique using the short-acting synthetic opioid, remifentanil, as part of an anesthetic technique to provide brief periods of apnea and the rapid resumption of spontaneous ventilation.Results:The study cohort included 12 patients (8 for high-resolution CT imaging and 4 for abdominal MR imaging) who ranged in age from 6 to 16 months. General anesthesia with spontaneous ventilation was induced with sevoflurane in air and oxygen. When apnea was required, remifentanil (3 &mgr;g/kg) was administered. Apnea occurred within 30–60 seconds following the bolus dose of remifentanil (42 ± 8 seconds). The duration of apnea varied from 3 to 8 minutes (4.8 ± 1.5 minutes). Following the administration of remifentanil, there was a decrease in heart rate (HR) from 127 ± 7 to a low of 108 ± 9 beats per minute (P < 0.0001). Systolic blood pressure (sBP) decreased from 84 ± 6 mm Hg to 78 ± 5 mm Hg (P = 0.0071). One patient received a fluid bolus (10 mL/kg) for a sBP of 56 mm Hg. No other adverse effects were noted.Conclusions:This technique facilitated anesthetic care by allowing the use of a laryngeal mask airway (LMA) for both the radiologic imaging as well as bronchoscopy which was performed after the radiologic imaging. The use of a bolus dose of remifentanil provided a brief period of apnea for the acquisition of the radiologic images.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

References1. Tobias JD. The laryngeal mask airway: a review for the emergency physician. Pediatr Emerg Care 1996;12:370–373.TobiasJDThe laryngeal mask airway: a review for the emergency physician.Pediatr Emerg Care199612370-3732. Badr A, Tobias JD, Rasmussen GE, et al. Bronchoscopic airway evaluation facilitated by the laryngeal mask airway in pediatric patients. Pediatr Pulmonol 1996;21:57–61.BadrA]]TobiasJD]]RasmussenGE&etal;Bronchoscopic airway evaluation facilitated by the laryngeal mask airway in pediatric patients.Pediatr Pulmonol19962157-613. Ross AK, Davis PJ, Dear Gd GL, et al. Pharmacokinetics of remifentanil in anesthetized pediatric patients undergoing elective surgery or diagnostic procedures. Anesth Analg 2001;93:1393–1401.RossAK]]DavisPJ]]DearGd GL&etal;Pharmacokinetics of remifentanil in anesthetized pediatric patients undergoing elective surgery or diagnostic procedures.Anesth Analg2001931393-14014. Ansermino JM, Brooks P, Rosen D, et al. Spontaneous ventilation with remifentanil in children. Pediatr Anaesth 2005;15:115–121.AnserminoJM]]BrooksP]]RosenD&etal;Spontaneous ventilation with remifentanil in children.Pediatr Anaesth200515115-1215. Crawford MW, Hayes J, Tan JM. Dose-response of remifentanil for tracheal intubation in infants. Anesth Analg 2005;100:1599–1604.CrawfordMW]]HayesJ]]TanJMDose-response of remifentanil for tracheal intubation in infants.Anesth Analg20051001599-16046. Batra YK, Al Qattan AR, Ali SS, et al. Assessment of tracheal intubating conditions in children using remifentanil and propofol without muscle relaxant. Pediatr Anaesth 2004;14:452–456.BatraYK]]Al QattanAR]]AliSS&etal;Assessment of tracheal intubating conditions in children using remifentanil and propofol without muscle relaxant.Pediatr Anaesth200414452-4567. Wee LH, Moriarty A, Cranston A, et al. Remifentanil infusion for major abdominal surgery in small infants. Paediatr Anaesth 1999;9:415–418.WeeLH]]MoriartyA]]CranstonA&etal;Remifentanil infusion for major abdominal surgery in small infants.Paediatr Anaesth19999415-4188. Klemola UM, Hiller A. Tracheal intubation after induction of anesthesia in children with propofol-remifentanil or propofol-rocuronium. Can J Anaesth 2000;47:854–859.KlemolaUM]]HillerATracheal intubation after induction of anesthesia in children with propofol-remifentanil or propofol-rocuronium.Can J Anaesth200047854-859