Remifentanil Requirement for Acceptable Intubating Condition

Study Overview
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Brief Summary
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Ketamine and opioid are known to improve the intubating condition, respectively. Combination of ketamine and opioid potentiate analgesic effect and give hemodynamic stability in complementary manner. Therefore, the combination use of ketamine and remifentanil could be useful for acceptable intubating condition in the general anesthesia without the use of neuromuscular blocking agent. Generally, induction dose of ketamine ranges between 1 and 2 mg. There was no report about the optimal dose of remifentanil with 1 or 2 mg ketamine induction dose for intubation without neuromuscular blocking agent. The investigators focus on remifentanil dose using Dixon's up and down method.

Official Title
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Remifentanil Requirement for Acceptable Intubating Condition With Two Dose Ketamine Without Neuromuscular Blocking Agent in Children

Conditions
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Intubating Condition

Intervention / Treatment
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* Drug: Ketamine 1
* Drug: Ketamine 2
* Drug: Remifentanil


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA I-II Undergoing general anesthesia with endotracheal tube Exclusion Criteria: Anticipated difficult airway Patient with upper respiratory infection within 14 days Asthma

Ages Eligible for Study
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Minimum Age: 3 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: ketamine 1<br>Anesthesia induction with ketamine 1 mg followed by remifentanil. | Drug: Ketamine 1<br>* Anesthesia induction is performed with 1 mg ketamine.<br>Drug: Remifentanil<br>* After anesthesia induction with ketamine, predetermined remifentanil using Dixon's up and dowm method is administered.<br>|
| Experimental: ketamine 2<br>Anesthesia induction with ketamine 2 mg followed by remifentanil. | Drug: Ketamine 2<br>* Anesthesia induction is performed with 2 mg ketamine.<br>Drug: Remifentanil<br>* After anesthesia induction with ketamine, predetermined remifentanil using Dixon's up and dowm method is administered.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| acceptability of intubation condition | For assessment of intubation condition, 5 variables will be individually evaluated though 3 point scale (excellent, good, poor). If all variables are graded as excellent, intubation condition will be excellent. If at least 1 variable is poor, it will be reported as poor. Otherwise, it will be reported as good. Good and excellent will be considered to be acceptable intubating condition. Poor will be reported as unacceptable intubating condition. Laryngoscope easiness Vocal cord position Vocal cord movement Movement of limb Coughing | during and after intubation, about 2 minute |