Yonsei Med J.  2008 Apr;49(2):211-216. 10.3349/ymj.2008.49.2.211.

Remifentanil Prevents Withdrawal Movements Caused by Intravenous Injection of Rocuronium

• Choi BI
• Choi SH
• Shin YS
• Lee SJ
• Yoon KB
• Shin SK
• Lee KY

• KMID: 1084492
• DOI: http://doi.org/10.3349/ymj.2008.49.2.211

Abstract

PURPOSE
The incidence of pain induced withdrawal movement following intravenous injection of rocuronium is high. This randomized, double-blind, placebo-controlled study was designed to evaluate the effect of pretreatment of remifentanil on the withdrawal movements due to intravenous injection of rocuronium during anesthetic induction. MATERIALS AND METHODS: Ninety adult female patients undergoing thyroidectomy were randomly allocated to three groups. Each patient intravenously received one of three solutions of equal volume (4 mL): normal saline (Group I, n=30), 0.5 microgram/kg remifentanil (Group II, n=30) or 1 microgram/kg remifentanil (Group III, n=30). Thirty seconds after remifentanil administration, anesthesia was induced with 5 mg/kg IV thiopental. Twenty seconds after thiopental injection, 0.6 mg/kg IV rocuronium was administered (injection rate of 0.5 mL/sec) and patients' withdrawal movements were assessed. Mean arterial pressure (MAP) and heart rate were assessed on arrival in the operation room, before the tracheal intubation and immediately, 1 and 2 min after the tracheal intubation. RESULTS: The incidence of withdrawal movements was significantly lower in both of the remifentanil groups (3 and 0% in Group II and III, respectively) than in the saline group (70%). Remifentanil attenuated the increase of heart rate and MAP immediately and 1 min after the tracheal intubation. CONCLUSION: The pretreatment with 0.5 and 1.0 microgram/kg remifentanil of bolus doses prevented the withdrawal movements caused by rocuronium injection, and effectively blunted cardiovascular activation following tracheal intubation.

Keyword

Remifentanil; rocuronium; withdrawal movements

MeSH Terms

Adult
Aged
Analgesics, Opioid/administration & dosage/therapeutic use
Androstanols/administration & dosage/*adverse effects
Female
Humans
Injections, Intravenous/adverse effects
Middle Aged
Pain/etiology/*prevention & control
Piperidines/administration & dosage/*therapeutic use

Figure

• 

  Fig. 1 Changes in heart rate during anesthetic induction. Base: before induction, Pre-intu: just before endotracheal intubation, imm.postintu: immediately after endotracheal intubation, postintu. 1 min: 1 min after endotracheal intubation, postintu 2 min: 2 min after endotracheal intubation. *p = 0.012, †p = 0.985, ‡p = 0.007 §p = 0.043, ‖p = 0.945, ¶p = 0.039.

• 

  Fig. 2 Changes in mean arterial pressure (MAP) during anesthetic induction. Base: before induction, Pre-intu: just before endotracheal intubation, imm.postintu: immediately after endotracheal intubation, postintu. 1 min: 1 min after endotracheal intubation, postintu 2 min: 2 min after endotracheal intubation. *p = 0.000, †p = 0.987, ‡p = 0.000, §p = 0.036, ‖p = 0.617, ¶p = 0.002, **p = 0.008.

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