Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Aug 18;25(1):629.
doi: 10.1186/s12887-025-06010-y.

Effect of the combination of remifentanil and neuromuscular blockers in pediatric endotracheal intubation: a prospective, double-blinded, randomized clinical trial

Lanxin Qiao  1 , Di Zhang  2 , Zhengzheng Gao  1 , Tingting Zi  1 , Jianmin Zhang  1 , Lijing Li  1 , Fang Wang  3
Affiliations
Randomized Controlled Trial

Effect of the combination of remifentanil and neuromuscular blockers in pediatric endotracheal intubation: a prospective, double-blinded, randomized clinical trial

Lanxin Qiao et al. BMC Pediatr. .

Abstract

Background: Endotracheal intubation must be performed more carefully in children than in adults, as children are likely to more serious consequences due to the buck, move, and hemodynamic changes during the procedure. The aim of this study was to explore whether increasing the use of remifentanil during anesthesia induction can further improve the effectiveness and safety of tracheal intubation in children.

Design: This double-blind clinical trial included patients who underwent elective surgery under general anesthesia for intubation at Beijing Children's Hospital.

Methods: One hundred thirty-eight pediatric patients aged 1-12 years, classified as having American Society of Anesthesiologists (ASA) physical status I or II, who received general anesthetics for elective surgery were randomly divided into a remifentanil group (group R) (n = 69) and a placebo group (group C) (n = 69). In group R, 1 µg/kg remifentanil was intravenously infused after the intravenous infusion of other induction drugs. In group C, the same volume of normal saline was injected intravenously. The primary outcome measure was successful intubation at the first attempt with no adverse events.

Results: In total, 129 patients (64 in the group R and 65 in the group C) were enrolled. The incidence of first-attempt successful tracheal intubation with no adverse events was greater in group R (87.5%, n = 56) than in group C (60.0%, n = 39) (OR, 4.7; 95% CI = 1.9-11.4; p < 0.001).

Conclusions: Compared with the use of cisatracurium alone, the combination of low-dose remifentanil with cisatracurium was associated with a higher rate of successful first-attempt intubation without adverse events.

Trial registration: Chinese Clinical Trial Registry. Retrospectively registered. Identifier: ChiCTR2400089691. Date: 13/9/2024.

Keywords: Intubation-related adverse events; Pediatric; Remifentanil.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: This clinical trial was approved by the Ethics Committee of Beijing Children’s Hospital, Capital Medical University (approval number: [2024]-Y-048-D, date of approval: 15/3/2024) and registered in the Chinese Clinical Trial Registry (registration number: ChiCTR2400089691; date of registration: 13/9/2024). All methods were performed in accordance with the Declaration of Helsinki. All the legal guardians of the children enrolled in the study signed informed consent forms before their child were enrolled in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow chart of the study
Fig. 2
Fig. 2
Mean arterial pressure and heart rate at each time point in the two groups. T0: baseline; T1: immediately before intubation; T2: immediately after intubation; T3: 5 min after intubation
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Morray JP, Geiduschek JM, Caplan RA, et al. A comparison of pediatric and adult anesthesia closed malpractice claims. Anesthesiology. 1993;78:461–7. - PubMed
    1. Tamire T, Garbessa B, Gebeyehu G, et al. Tracheal intubation-related adverse events in pediatrics anesthesia in Ethiopia. Paediatr Anaesth. 2021;31:515–21. - PubMed
    1. Short CE, Bufalari A. Propofol anesthesia. Vet Clin North Am Small Anim Pract. 1999;29:747–78. - PubMed
    1. Sepulveda PO, Mora X. Reevaluation of the time course of the effect of propofol described with the Schnider pharmacokinetic model. Rev Esp Anestesiol Reanim. 2012;59:542–8. - PubMed
    1. Wang F, Zhang J, Yu J, et al. Variation of bispectral index in children aged 1–12 years under propofol anesthesia: an observational study. BMC Anesthesiol. 2019;19:145. - PMC - PubMed

Publication types

LinkOut - more resources