Comparison of remifentanil with alfentanil or suxamethonium following propofol anaesthesia for tracheal intubation

Purpose: To compare the intubating conditions after remifentanil-propofol with those after propofol-rocuronium combination with the aim of determining the optimal dose of remifentanil.Methods: In a randomized, double-blind study 80 healthy children aged three to nine years were assigned to one of four groups (n=20): 2 or 4 µg·kg -1 remifentanil (Re2 or Re4); 2 µg·kg -1 remifentanil and 0.2 mg·kg -1 rocuronium (Re2-Ro0.2); 0.4 mg·kg -1 rocuronium (Ro0.4). After atropine, remifentanil was injected over 30 sec followed by 3.5 mg·kg -1 propofol and rocuronium. After 60 sec, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor based on ease of ventilation, jaw relaxation, position of the vocal cords, and coughing to intubation.Results: In all children intubation was successful. Overall intubating conditions were better (P < 0.01), and the frequency of excellent conditions, 85%, was higher (P < 0.01) in the Re4 group than in the Ro0.4 group. No child manifested signs of muscular rigidity. In the remifentanil groups, arterial pressure decreased 11-13% and heart rate 6-9% after anesthetic induction, and remained at that level throughout the study. Conclusion:The best intubating conditions were produced by the combination of 4 µg·kg -1 remifentanil and 3.5 mg·kg -1 propofol. It provided excellent or good intubating conditions in all children without causing undue cardiovascular depression.Objectif : Comparer les conditions d'intubation après l'usage d'une combinaison de rémifentanil-propofol avec celles d'une combinaison de propofol-rocuronium dans le but de déterminer la dose optimale de rémifentanil.Méthode : Lors d'une étude randomisée et à double insu, 80 enfants en bonne santé, de trois à neuf ans, ont été répartis en quatre groupes (n=20) et ont reçu : 2 ou 4 µg·kg -1 de rémifentanil (Ré2 ou Ré4); 2 µg·kg -1 de rémifentanil et 0,2 mg·kg -1 de rocuronium (Ré2-Ro0,2); 0,4 mg·kg -1 de rocuronium. Après l'administration d'atropine, le rémifentanil a été injecté pendant 30 s et a été suivi de 3,5 mg·kg -1 de propofol et de rocuronium. La laryngoscopie et l'intubation ont été tentées après 60 s. Les conditions d'intubation ont été évaluées comme excellentes, bonnes ou pauvres selon la facilité de la ventilation, la relaxation de la mâchoire, la position des cordes vocales et la toux pendant l'intubation.Résultats : L'intubation a été réussie chez tous les enfants. Les conditions générales d'intubation ont été meilleures (P < 0,01), et la fréquence d'excellentes conditions, 85 %, plus élevée (P < 0,01) dans le groupe Ré4 que dans le groupe Ro0,4. Aucun enfant n'a manifesté de signe de rigidité musculaire. Dans les groupes rémifen-tanil, la tension artérielle a baissé de 11-13 % et la fréquence cardiaque de 6-9 % après l'induction de l'anesthésie et sont demeurées à ce niveau tout au long de l'étude. Conclusion :Les meilleures conditions d'intubation ont été réalisées avec la combinaison de 4 µg·kg -1 de rémifentanil et de 3,5 mg·kg -1 de propofol. L'intubation a été bo...

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Tracheal intubation after induction of anesthesia in children with propofol — remifentanil or propofol-rocuronium

Klemola

Hiller

2000

“…[7][8][9] Moreover, high rates of good to excellent intubating conditions have been reported without the use of NMBDs, provided that the anesthetic induction protocol is optimized with an adequate dose of an opioid analgesic co-administered with either propofol or thiopental. [10][11][12][13][14][15][16] Due to its rapid onset, remifentanil 2 µg·kg -1 , combined with propofol 2 mg·kg -1 , provides acceptable intubating conditions in 75 to 85% of patients. 11,12 However, no previous study has evaluated potential laryngeal morbidity associated with an optimized relaxant-free anesthetic induction protocol.…”

Section: Conclusion : à La Suite D'une Induction De L'anesthésie à L'mentioning

confidence: 99%

Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

Bouvet

Stoian

Jacquot-Laperrière

et al. 2008

Purpose:The need for muscular relaxation to improve intubating conditions and to reduce the incidence of laryngeal morbidity is still controversial. The aim of this study was to determine the incidence of symptomatic laryngeal injuries (SLI) and of acceptable intubating conditions (including both good and excellent conditions), both with and without cisatracurium during induction of anesthesia, along with moderate doses of remifentanil and propofol. Methods:In this prospective, randomized double-blind equivalence trial, the intubating conditions were compared in 130 ASA I or II female patients. All subjects received remifentanil 2 µg·kg -1 iv and propofol 2.5 mg·kg -1 iv, with either cisatracurium 0.15 mg·kg -1 iv (group Cisatracturium), or saline (group Placebo). Tracheal intubating conditions were assessed with the Copenhagen Score. A systematic screening for postoperative hoarseness and sore throat was performed 24 and 48 hr after anesthesia, followed by a nasofibroscopic examination when laryngeal symptoms persisted at 48 hr.Results: Twenty-four hr after anesthesia, the incidence of postoperative hoarseness and sore throat in the Cisatracurium and Placebo groups was 26.5% and 21.5%, respectively, and 48 hr after anesthesia, the incidence was 7.8% and 6.1%, respectively (P = 0.32 and P = 0.50 between groups, respectively). In the clinically evaluable population, the incidence of SLI, assessed at 48 hr by nasofibroscopy, was equivalent in both groups, 1.6% vs 1.5% in group Placebo and group Cisatracurium, respectively (P < 0.001 for equivalence test), as was the occurrence of acceptable intubating conditions (95.4% vs 100%, P < 0.05 for equivalence test). However, the occurrence of excellent intubating conditions was more frequent in group Cisatracurium than in group Placebo (P = 0.0003). Conclusion:Following induction of anesthesia with propofol and moderate-dose remifentanil, cisatracurium did not confer a higher rate of good-to-excellent conditions for tracheal intubation, nor did muscle relaxation with cisatracurium decrease the rate of SLI after tracheal intubation.

“…Numerous reports have also demonstrated similar intubating conditions, in the absence of muscle relaxants, using remifentanil and propofol as the co-induction agents. [18][19][20][21][22][23][24] Recently, induction with remifentanil and sevoflurane has enabled rapid endotracheal intubation without the use of muscle relaxants. 25 What remained to be seen was whether sevoflurane-remifentanil induction, a novel technique, would decrease the frequency of PONV compared to standard practice.…”

Section: Résultats : Aucune Différence Intergroupe N'a éTé Enregistrémentioning

confidence: 99%

Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery

Yang

Choi

McChesney

et al. 2004

P Pu ur rp po os se e: : To compare sevoflurane-remifentanil induction and propofol-fentanyl-rocuronium induction with regards to the frequency of moderate to severe postoperative nausea and vomiting (PONV) in the first 24 hr after laparoscopic day surgery.M Me et th ho od ds s: : After informed consent, 156 ASA physical status class I to III patients undergoing laparoscopic cholecystectomy or tubal ligation were randomized to either induction with sevoflurane 8%, N 2 O 67% and iv remifentanil 1 to 1.5 µg·kg -1 or induction with iv fentanyl 2 to 3 µg·kg -1 , propofol 2 mg·kg -1 , and rocuronium 0.3 to 0.5 mg·kg -1 . All patients received iv ketorolac 0.5 mg·kg -1 at induction and sevoflurane-N 2 O maintenance anesthesia with rocuronium as needed. PONV was treated with iv ondansetron, droperidol, or dimenhydrinate; postoperative pain was treated with opioid analgesics. Patients were followed for 24 hr with regards to PONV and pain. Intubating conditions, induction and emergence times, time to achieve fast-track discharge criteria, and drug costs were measured. R Re es su ul lt ts s: : No differences were seen between the two groups in their frequencies of 24-hr moderate to severe PONV and postoperative pain, or in their intubating conditions, induction and emergence times, and time to achieve fast-track discharge criteria. Patients undergoing sevoflurane-remifentanil induction received more morphine (11 mg vs 8 mg; P < 0.001) in the postanesthetic care unit. Sevoflurane-remifentanil induction resulted in similar anesthetic and total drug costs for both procedures.C Co on nc cl lu us si io on n: : We did not demonstrate any difference in PONV, pain, or anesthetic/recovery times or costs between the sevoflurane and propofol groups. Sevoflurane-remifentanil induction is a feasible technique for anesthetic induction. Objectif : Comparer l'induction avec sévoflurane-rémifentanil ou propofol-fentanyl-rocuronium quant à la fréquence de nausées et vomissements postopératoires (NVPO) de modérés à sévères pendant les 24 premières heures après une opération en chirurgie d'un jour sous laparoscopie. Méthode : Après avoir accordé leur consentement, 156 patients d'état