Résumé
The use of Remifentanil has never been studied during rapid sequence induction (RSI) in pediatrics, where the risk of hypoxia is added to that of inhalation. The objective was to assess the feasibility and tolerance of Remifentanil as an alternative to neuromuscular blockers during RSI in a selected pediatric population. Methods: in this study, we investigated children who underwent RSI between December 2021 and August 2023. They were included if they had an RSI and did not receive neuromuscular blockers during induction. The evaluated criteria were firstly the rate of successful orotracheal intubation (OTI) on the first attempt without major complications, secondarily minor complications, intubation conditions, and the impact of prophylactic atropine use. Results: 267 children were analyzed, with an average age of 7.8 years. Remifentanil was administered at an average dose of 3.19 μg/kg. There were no major complications. OTI was successful on the first attempt in 93% of cases. Minor hypotension was noted in 13.9% of cases, along with 3 cases of minor bradycardia and 3 cases of minor desaturation. Intubation conditions were good or excellent in 73% of cases. After propensity score matching, the groups with and without prophylactic atropine were comparable, and it appears to reduce complications. Conclusion: the use of Remifentanil as an alternative to muscle relaxants during pediatric RSI appears to be effective and well-tolerated. However, its use should be reserved for a selected population yet to be defined and for a specialized team.