Prevention of withdrawal movement associated with injection of rocuronium in children: comparison of remifentanil, alfentanil and fentanyl

BACKGROUND: We compared the efficacy of remifentanil, alfentanil and fentanyl in reducing withdrawal movement associated with the injection of rocuronium in children. METHODS: In total, 164 ASA physical status I or II pediatric patients, aged 1-14 years, were randomly assigned to four treatment groups: group C received saline; group R, remifentanil 1 microg/kg; group A, alfentanil 10 micro/kg; and group F, fentanyl 2 microg/kg. Treatments were injected over 30 s, followed by thiopental 5 mg/kg. At 90 s after the start of the study drug injection, rocuronium 0.6 mg/kg was injected over 10 s. The patient's response to the injection of rocuronium was graded on a four-point scale in a double-blinded manner. RESULTS: The incidence of withdrawal movement was 89.5% in group C, 70.3% in group F, 36.3% in group A and 7.2% in group R. The incidence of generalized movement (grade 4) was 86.9% in group C, 58.5% in group F, 15.9% in group A and 2.4% in group R. CONCLUSION: Remifentanil, alfentanil and fentanyl all reduced the incidence of withdrawal movement when administered 90 s before the injection of rocuronium compared with saline. Remifentanil was the most effective, followed by alfentanil. Fentanyl was less effective but significantly different from the saline in reducing withdrawal movement in children.