Objective To test the hypothesis that remifentanil, because of its favorable pharmacokinetic properties, would be advantageous to use in combination with midazolam to provide analgesia and sedation during brief painful procedures.
Design Prospective observation and data collection.
Setting University hospital.
Patients Seventeen children aged 2 to 12 years, who underwent 20 brief, painful procedures.
Interventions Administration of intravenous midazolam hydrochloride, 0.05 mg/kg, and remifentanil hydrochloride, 1 µg/kg, followed by a remifentanil infusion at 0.1 µg·kg-1·min-1. The dose was titrated at 5-minute intervals to levels of sedation and analgesia.
Main Outcome Measures Successful remifentanil doses, times to discharge readiness, side effects, complications, and requirement for additional medications.
Results The technique was successful in 17 of 20 procedures. The mean±SD successful dose was 0.4±0.2 µg·kg-1·min-1. Four children developed hypoxemia that abated with mild stimulation; 1 child became unresponsive and required positive-pressure ventilation. The mean±SD time to reach discharge criteria was 9.5±4.3 minutes. Hypoxemia was avoided in 10 of 13 patients by continuous stimulation throughout the procedure.
Conclusion The use of remifentanil and midazolam during brief, painful procedures results in rapid times to discharge but is complicated by a high incidence of life-threatening respiratory depression at subtherapeutic levels.
