Hostname: page-component-7c8c6479df-ws8qp Total loading time: 0 Render date: 2024-03-28T08:52:41.360Z Has data issue: false hasContentIssue false

Tracheal intubation without muscle relaxants: remifentanil or alfentanil in combination with propofol

Published online by Cambridge University Press:  02 June 2005

E. Erhan
Affiliation:
Ege University, Department of Anaesthesiology and Reanimation, Faculty of Medicine, Izmir, Turkey
G. Ugur
Affiliation:
Ege University, Department of Anaesthesiology and Reanimation, Faculty of Medicine, Izmir, Turkey
I. Alper
Affiliation:
Ege University, Department of Anaesthesiology and Reanimation, Faculty of Medicine, Izmir, Turkey
I. Gunusen
Affiliation:
Ege University, Department of Anaesthesiology and Reanimation, Faculty of Medicine, Izmir, Turkey
B. Ozyar
Affiliation:
Ege University, Department of Anaesthesiology and Reanimation, Faculty of Medicine, Izmir, Turkey
Get access

Extract

Summary

Background and objective: In some situations, the use of muscle relaxants (neuromuscular blocking drugs) are undesirable or contraindicated. We compared intubating conditions without muscle relaxants in premedicated patients receiving either alfentanil 40 μg kg−1 or remifentanil 2, 3 or 4 μg kg−1 followed by propofol 2 mg kg−1.

Methods: In a randomized, double-blind study, 80 healthy patients were assigned to one of four groups (n = 20). After intravenous atropine, alfentanil 40 μg kg−1 or remifentanil 2, 3 or 4 μg kg−1 were injected over 90 s followed by propofol 2 mg kg−1. Ninety seconds after administration of the propofol, laryngoscopy and tracheal intubation were attempted. Intubating conditions were assessed as excellent, good or poor on the basis of ease of lung ventilation, jaw relaxation, laryngoscopy, position of the vocal cords, and patient response to intubation and slow inflation of the endotracheal tube cuff.

Results: Seven patients who received remifentanil 2 μg kg−1 and one patient who received remifentanil 3 μg kg−1 could not be intubated at the first attempts. Excellent intubating conditions (jaw relaxed, vocal cords open and no movement in response to tracheal intubation and cuff inflation) were observed in those who received either alfentanil 40 μg kg−1 (45% of patients) or remifentanil in doses of 2 μg kg−1 (20%), 3 μg kg−1 (75%) or 4 μg kg−1 (95%). Overall, intubating conditions were significantly better (P < 0.05), and the number of patients showing excellent conditions were significantly higher (P < 0.05) in patients who received remifentanil 4 μg kg−1 compared with those who received alfentanil 40 μg kg−1 or remifentanil 2 μg kg−1. No patient needed treatment for hypotension or bradycardia.

Conclusions: Remifentanil 4 μg kg−1 and propofol 2 mg kg−1 administered in sequence intravenously provided good or excellent conditions for tracheal intubation in all patients without the use of muscle relaxants.

Type
Original Article
Copyright
© 2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Scheller MS, Zornow MH, Saidman LJ. Tracheal intubation without the use of muscle relaxants: a technique using propofol and varying doses of alfentanil. Anesth Analg 1992; 75: 788793.Google Scholar
Beck GN, Masterson GR, Richards J, Bunting P. Comparison of intubation following propofol and alfentanil with intubation following thiopentone and suxamethonium. Anaesthesia 1993; 48: 876880.Google Scholar
Davidson JA, Gillespie JA. Tracheal intubation after induction of anaesthesia with propofol, alfentanil and IV lidocaine. Br J Anaesth 1993; 70: 163166.Google Scholar
Thompson JP, Rowbotham DJ. Remifentanil – an opioid for the 21st century. Br J Anaesth 1996; 76: 341343.Google Scholar
Glass PSA, Hardman D, Kamiyama Y, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (G187084B). Anesth Analg 1993; 77: 10311040.Google Scholar
Egan TD, Minto CF, Hermann DJ, et al. Remifentanil versus alfentanil: comparative pharmacokinetics and pharmacodynamics in healthy adult male volunteers. Anesthesiology 1996; 84: 821833.Google Scholar
Mallampati S, Gatt S, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can J Anaesth 1985; 32: 429434.Google Scholar
Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants. Anesth Analg 1998; 86: 4549.Google Scholar
Kleomola UM, Mennander S, Saarnivaara L. Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol. Acta Anaesthesiol Scand 2000; 44: 465469.Google Scholar
Woods AW, Grant S, Davidson JA. Duration of apnoea with two different intubating doses of remifentanil. Eur J Anaesthesiol 1999; 16: 634637.Google Scholar
Grant S, Noble S, Woods A, Murdoch J, Davidson JAH. Assessment of intubating conditions in adults after induction with propofol and varying doses of remifentanil. Br J Anaesthesia 1998; 81: 540543.Google Scholar
Kazama T, Ikeda K, Morita K. Reduction by fentanyl of the Cp50 values of propofol and hemodynamic responses to various noxious stimuli. Anesthesiology 1997; 87: 213227.Google Scholar
Alexander R, Olufolabi A, Booth J, El Moalem H, Glass PS. Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants. Anaesthesia 1999; 54: 10371040.Google Scholar
Woods AW, Grant S. Remifentanil and intubating conditions. Anaesthesia 2000; 55: 516518.Google Scholar
Thompson JP, Hall AP, Russell J, Cagney B, Rowbotham DJ. Effect of remifentanil on the haemodynamic response to orotracheal intubation. Br J Anaesth 1998; 80: 467469.Google Scholar
Sebel PS, Hoke JF, Westmoreland C, et al. Histamine concentrations and hemodynamic responses after remifentanil. Anesth Analg 1995; 80: 990993.Google Scholar
Moss J, Renz CL. The autonomic nervous system. In: Miller RD, ed. Anesthesia, 5th edn. Pennsylvania, USA: Churchill Livingstone, 2000: 564565.
Ding Y, Fredman B, White PF. Use of mivacurium during laparoscopic surgery: effect of reversal drugs on postoperative recovery. Anesth Analg 1994; 78: 450454.Google Scholar
Bailey PL, Egan TD, Stanley TH. Intravenous opioid anaesthetics. In: Miller RD, ed. Anesthesia, 5th edn. Pennsylvania, USA: Churchill Livingstone, 2000: 273376.