Conscious sedation with remifentanil and midazolam during brief painful procedures in children

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 mirdazolam hydrochloride, 0.05 mg/kg, and remifentanil hydrochloride, I mu g/kg, followed by a remifentanil infusion at 0.1 pg 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 mu g 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.