RT Journal
A1 Litman RS
T1 COnscious sedation with remifentanil and midazolam during brief painful procedures in children
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 1999
FD October 1
VO 153
IS 10
SP 1085
OP 1088
DO 10.1001/archpedi.153.10.1085
UL http://dx.doi.org/10.1001/archpedi.153.10.1085
AB 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.