Hs. Joo et al., Sevoflurane with remifentanil allows rapid tracheal intubation without neuromuscular blocking agents, CAN J ANAES, 48(7), 2001, pp. 646-650
Citations number
12
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
CANADIAN JOURNAL OF ANAESTHESIA-JOURNAL CANADIEN D ANESTHESIE
Purpose: After inhalational induction with sevoflurane, we compared the eff
ects of adding remifentanil 1 mug(.)kg(-1) or remifentanil 2 mug(.)kg(-1) o
n conditions for tracheal intubation without neuromuscular blocking agents.
Methods: Before anesthetic induction, all patients were given 0.2 mg of gly
copyrrolate iv to counteract the bradycardic effects of remifentanil. Two m
inutes after inhalational induction with 8% sevoflurane and 50% nitrous oxi
de, 56 female patients with normal airways scheduled for gynecologic surger
y were randomized to receive remifentanil 1 or 2 mug(.)kg(-1) in a double-b
lind fashion. One minute later, laryngoscopy was initiated for tracheal int
ubation. Conditions for tracheal intubation and hemodynamic response to tra
cheal intubation were assessed.
Results: Tracheal intubation was successful in all patients. The incidence
of post-intubation coughing was lower in the remifentanil 2 mug(.)kg(-1) gr
oup compared to remifentanil 1 mug(.)kg(-1) group (11% vs 39%, P < 0.02). O
ptimal intubation conditions were also higher in the remifentanil 2 mug(.)k
g(-1) group at 89% vs 54% (P < 0.01). However, the higher dose of remifenta
nil also resulted in a greater decrease in mean arterial pressure (P < 0.05
).
Conclusions: The addition of remifentanil after sevoflurane induction allow
s for rapid tracheal intubation without neuromuscular blocking agents. The
higher dose of remifentanil results in improved conditions for tracheal int
ubation but also caused a greater decrease in mean arterial pressure. Trach
eal intubation using sevoflurane and remifentanil may be an alternative to
traditional tracheal intubation with neuromuscular blocking agents.