Comparison of Alfentanil With Suxamethonium in Facilitating Nasotracheal Intubation in Day-Case Anaesthesia

Abstract

We have performed a prospective study in 100 adults (ASA I or II) undergoing day-case dental extraction to compare the conditions for intubation and the postoperative sequelae of suxamethonium and alfentanil as adjuncts to propofol. The patients were allocated randomly to two groups comparable in age, sex and weight. Successful intubation was achieved in 100% of the suxamethonium group and 90% of the alfentanil group. Of the patients who received suxamethonium, 74% developed myalgia on the day after surgery, compared with 20% in the alfentanil group (P < 0.001). The proportion of patients who developed sore throat was also less in the alfentanil group than in the suxamethonium group (P < 0.05). The proportion of patients who complained of nausea in the two groups was not significantly different. We conclude that alfentanil, as an adjunct to propofol to facilitate tracheal intubation, is more acceptable to patients than suxamethonium in anaesthesia for day-case surgery.

Tracheal intubation of outpatients with and without muscle relaxants

“…However, additional administration of muscle relaxants improves visibility and success rate but comes at a price -myalgia. 7 The incidence of myalgia is > 70% with the use of succinylcholine alone as shown in this and previous studies. 7 Coadminstration of alfentanil lowered the incidence of myalgia to approximately 20% for most muscle groups but was still approximately 50% for the neck muscles.…”

“…7 The incidence of myalgia is > 70% with the use of succinylcholine alone as shown in this and previous studies. 7 Coadminstration of alfentanil lowered the incidence of myalgia to approximately 20% for most muscle groups but was still approximately 50% for the neck muscles. This protective effect of alfentanil has been confirmed by previous studies where the incidence of succinylcholine induced myalgias was reduced from 74% to 20% with the adjunctive administration of 10 µg·kg -1 alfentanil.…”

“…This protective effect of alfentanil has been confirmed by previous studies where the incidence of succinylcholine induced myalgias was reduced from 74% to 20% with the adjunctive administration of 10 µg·kg -1 alfentanil. 7 Precurarisation with 3 mg of d-tubocurarine was better than alfentanil in reducing the incidence and severity of myalgias. The incidence of myalgia was reduced, at best, to <10% and, at worst, to < 50% by pretreatment with tubocurarine.…”

“…1,2,4-7 Propofol alone or in combinations with small (< 40 µg·kg -1) doses of alfentanil was more likely to be associated with suboptimal intubating conditions. 1,[4][5][6][7] Similarly, propofol in conjunction with < 3 µg·kg -1 of remifentanil was associated with suboptimal intubating conditions. 2 However, these studies employed multiple anesthesiologists for intubation.…”

“…The use of alfentanil in doses > 20 µg·kg -1 appears to overcome movement during intubation. 1,[4][5][6][7] The adjunctive administration of lidocaine 1 mg·kg -1 appears to reduce coughing during intubation. 5 Poor visibility during laryngoscopy can be subjective and is dependent on the experience of the anesthesiologist.…”