Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants

Abstract

SummarySixty ASA I and II patients, premedicated with midazolam, were administered propofol 2 mg.kg ¹1 and remifentanil 3 mg.kg ¹1 (group R3), remifentanil 4 mg.kg ¹1 (group R4) and remifentanil 5 mg.kg ¹1 (group R5). Laryngoscopy and intubation were performed 1 min after the administration of the study drugs and the intubating conditions were assessed. Good to excellent conditions were observed in 12 patients in group R3 compared with 19 patients each in groups R4 and R5 (p ¼ 0.004). Significant reductions in mean arterial pressure (MAP) and heart rate (HR) after administration of the study drug were observed in each group, p < 0.01. There was, however, no difference in mean MAP and HR between the three groups at all time points. We conclude that remifentanil 4-5 mg.kg ¹1 may reliably provide good to excellent conditions for tracheal intubation when administered after propofol 2 mg.kg ¹1 .

Fentanyl is more effective than remifentanil at preventing increases in cerebral blood flow velocity during intubation in children

“…These findings are in agreement with adult studies, which demonstrated significant decreases in MAP when higher doses of remifentanil were used either as a bolus or continuous infusion. 17,18 The decrease in CBFV prior to tracheal intubation seemed to coincide with a decrease in MAP in the present study, suggesting that remifentanil may be associated with impaired cerebral blood pressure autoregulation. Alternatively, remifentanil may have decreased MAP to pressures below the lower limit of cerebral autoregulation.…”

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

“…27 In the present study, the mean reduction in MAP after anesthetic induction, 11-13%, was of a similar magnitude as thatreported by Robinson et al after 1 µg·kg -1 remifentanil, 12 but considerably less than that after 2 or 4 µg·kg -1 remifentanil shown by Alexander et al . 4,11 In the present study, pretreatment with atropine might have constituted a link for the absence of cardiovascular depression. Without a concurrent anticholinergic agent remifentanil was associated with bradycardia or hypotension, or both, in 30-50% of healthy patients during anesthetic induction and intubation.…”

“…Our results are in agreement with those obtained previously, in which drug combination and dosage were similar to ours. 10,11 The absence of signs of rigidity in our patients might have been due to the moderate injection rate of remifentanil. It has been suggested that the incidence and severity are dependent not only on the dose but the rate of administration.…”

“…4 In order to ensure good intubating conditions a dose of 3-4 µg·kg -1 remifentanil was required. 10,11 In children, intubating conditions were similar after 1 µg·kg -1 remifentanil or 15 µg·kg -1 alfentanil followed by propofol. 12 However, neither dose appeared optimal regarding intubating conditions.…”

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

“…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.…”