Heart Diseases Clinical Trial
Official title:
Study to Evaluate the Optimal Dose of Remifentanil Required to Ensure Apnoea During Magnetic Resonance Imaging of the Heart Under General Anaesthesia
What is the optimal maintenance dose of remifentanil to ensure apnoea, during breath hold episodes in children having cardiac MR imaging with general anaesthesia?
The management of congenital heart disease depends upon accurate imaging of the heart to
define anatomical abnormalities. The use of magnetic resonance imaging has grown in response
to this need. Young children, however, are unable to cooperate sufficiently to allow the scan
to occur; this necessitates the use of general anaesthesia.
The optimal anaesthetic management of children in this situation is complex. Imaging of an
acceptable quality depends on a low (normal) heart rate which is relatively constant during
the scan and frequent breath holds to avoid respiratory artefacts. Children undergoing such
scans commonly have significant cardiac and non-cardiac disease. A technique, currently used
at Alder Hey Hospital, is to use intravenous agents to provide anaesthesia: commonly a
mixture of the intravenous anaesthetic propofol and the potent opiate remifentanil. The
patient's own ventilation is suppressed by the use of remifentanil which also reduces heart
rate and heart rate variability. Controlled ventilation is provided via a ventilator and
endotracheal tube. Adequate doses of remifentanil are required to ensure suppression of the
patient's ventilation whilst excess doses are avoided to reduce the risk of adverse effects
(primarily arterial hypotension) and ensure rapid recovery.
Remifentanil dose has been studied during surgery(3-6), however this is a unique indication
and optimal dosage has not been formally studied. In particular the absence of any
stimulation from surgery is likely to mean that substantially lower doses of remifentanil
will be required.
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