The Effect of Rocuronium Administration Rate and Remifentanil on the Prevention of Rocuronium Injection Pain in Pediatric Cases

Aim: In the present study, we aimed to determine the effect of remifentanil administration prior to slow and fast rocuronium injektion on hemodynamic changes and rocuronium injection pain, compared with placebo, in pediatric patients. Methods: 120 5-15-year-old and American Society of Anesthesiologists (ASA) score I/II pediatric patients who scheduled for elective surgery under general anesthesia included in the study. Patients those without premedication were routinely monitored in the operation room. Anesthesia was induced with intravenous 2.5% thiopental sodium (5 mg/kg) followed by 0.6 mg per kg of rocuronium administration to all patients. After rocuronium injection, anesthesia was maintained with the combination of 50% O2 and 50% nitrogen protoxide and 6% desflurane. Patients were randomly allocated into four groups: group A: slow rocuronium injection-saline; group B: slow rocuronium injection (0.6 mg/kg IV)- remifentanyl; group C: fast rocuronium injection-saline; group D: fast rocuronium injection- remifentanyl. Slow and fast rocuronium administration was performed within one minute and five seconds, respectively. Withdrawal movement after rocuronium injection was recorded based on a 3-point response to withdrawal score. Systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR) and oxygen saturation (OS) was recorded before and after anesthesia induction, after rocuronium injection, first and third minutes after tracheal intubation, and during extubation and postoperative period. Results: The demographic data were comparable among all groups (p>0,05). There were no statistically significant differences in SBP, DBP and OS baseline values among four groups. One minutes after rocuronium injection, HR values were found to be lower in remifentanil groups (p:0,0001; 101,4±22,1, p:0,003; 99,8±18,3 in group B and D, respectively) compared with placebo groups (p:0,025; 107,4±21,7 , p: 0,012; 114,0±16,4 in group A and C, respectively). With respect to response to withdrawal scores, unresponsiveness rates were the highest in group B (%66,7) and group D (%70). The number of non-responder patients was 9 in saline-administered groups (group A and C), whereas it was 20 and 21 in remifentanil-administered groups (group B and D, respectively). Generalized responses were observed predominantly in group A (20%) and C (20%). The number of patients with generalized response was highest in group A (20%, n=6) and C (20%, n=6). Conclusion: There was no impact of infusion speed on rocuronium injection pain in pediatric cases, whereas it is concluded that remefentanil administration prior to rocuronium injection considerably reduced rocuronium injection pain regardless injection speed and without serious hemodynamic changes. Keywords: Rocuronium; injection pain, fast injection, slow injection, pediatric patients, remifentanil.