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 midazolam hydrochloride, 0.05 mg/kg, and remifentanil hydrochloride, 1 microg/kg, followed by a remifentanil infusion at 0.1 microg x kg(-1) x 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 microg x kg(-1) x 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.