Sevoflurane with remifentanil allows rapid tracheal intubation without neuromuscular blocking agents

Citation
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
ISSN journal
0832-610X → ACNP
Volume
48
Issue
7
Year of publication
2001
Pages
646 - 650
Database
ISI
SICI code
0832-610X(200107/08)48:7<646:SWRART>2.0.ZU;2-1
Abstract
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.