Intubation under induction doses of propofol

Keaveny, J.; Knell, P.J.W.

doi:10.1111/j.1365-2044.1988.tb09079.x

Cited by 76 publications

(31 citation statements)

References 5 publications

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“…However, the optimal dose of remifentanil required for providing excellent intubating conditions when co-administered with propofol remains unknown since published results are inconsistent [7][8][9][10][11][12][13][14]. This may be related to different protocols with respect to the timing and the speed of infusion of remifentanil and propofol, and the timing and assessment of tracheal intubation.…”

Section: Discussionmentioning

confidence: 99%

Optimal remifentanil dosage for providing excellent intubating conditions when co‐administered with a single standard dose of propofol

et al. 2009

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SummaryThis dose-response study aimed to determine the dose of remifentanil combined with propofol 2.5 mg.kg )1 which provided excellent intubation conditions in 95% of patients. Ninety premedicated female ASA 1 and 2 patients were randomly allocated to five remifentanil dose groups (1, 2, 3, 4 or 5 lg.kg )1 ). Induction of anaesthesia was performed with a blinded dose of remifentanil infused over 60 s simultaneously co-administered with propofol 2.5 mg.kg )1 infused over 45 s. Tracheal intubation was attempted 150 s after the beginning of induction. Intubating conditions were assessed with the Copenhagen score. A probit analysis was performed to calculate the intubating efficient doses (IED) of remifentanil in 95% of patients (IED 95 ). Our data revealed that the IED 95 of remifentanil was 4.0 (95% CI: 3.4-5.6) lg.kg, which was associated with a maximum decrease in heart rate and mean arterial pressure of < 30%, a finding which also applied to the other groups. Excellent intubating conditions are important to minimise the occurrence of damage to the airway, the fourth highest cause of claims related to injuries associated with general anaesthesia [1,2]. The use of neuromuscular blocking drugs at induction of anaesthesia provides significantly better intubating conditions and less vocal cord sequelae than relaxant-free anaesthesia, and has therefore been advocated prior to tracheal intubation for elective surgery [2,3].However, patient factors may contraindicate the use of neuromuscular blocking drugs, and administration of these drugs is associated with several complications, including anaphylactic reactions, residual curarisation, and awareness during general anaesthesia [4][5][6].Significant improvements in the quality of tracheal intubation without paralysis were reported when remifentanil was co-administered with propofol 2 or 2.5 mg.kg )1 [7][8][9][10][11][12][13]. However, the optimal dose of remifentanil required for providing excellent intubating conditions when co-administered with propofol remains unknown since published results are inconsistent [7][8][9][10][11][12][13][14]. This may be related to different protocols with respect to the timing and the speed of infusion of remifentanil and propofol, and the timing and assessment of tracheal intubation.Using an optimised sequence of induction of anaesthesia and a standardised scale for the assessment of the quality of tracheal intubation we therefore conducted a dose-response study to determine the intubating efficient dosage (IED) of remifentanil co-administered with propofol 2.5 mg.kg )1 which would provide excellent intubating conditions in 95% (IED 95 ) of patients undergoing elective surgery. Methods PatientsAfter approval of the study by our institution's Ethics Committee and obtaining patients' written consent, female patients scheduled for elective gynaecological surgery requiring tracheal intubation were enrolled. Inclusion criteria were: ASA 1 and 2 physical status, age from 18 to 65 years and body mass index from 20 to 24 kg.m )2 . Patients ...

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Section: Discussionmentioning

confidence: 99%

Optimal remifentanil dosage for providing excellent intubating conditions when co‐administered with a single standard dose of propofol

et al. 2009

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“…With this technique, 19 of 20 patients could be intubated, 12 of them smooth and easy 103 [III]. The technique was, however, followed by undesirable haemodynamic responses.…”

Section: Introductionmentioning

confidence: 99%

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Jensen

Callesen

Hagemo

et al. 2010

Acta Anaesthesiol Scand

115

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Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high‐grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre‐operative gastric emptying is rarely indicated. For pre‐oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre‐oxygenation in the obese patients should be performed in the head‐up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1–1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia.

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“…However, in some situations, e. g. , a full stomach, difficult intubation, and certain neuromuscular diseases, the administration of these agents is considered controversial. Therefore, other agents and methods, such as opioid agents, intravenous (propofol instead of thiopental) or inhaled (sevofluran) hypnotics can be usedin such situations to facilitate endotracheal intubation (1)(2)(3)(4). Opioids are agents that suppress respiration in addition to providing appropriate conditions for endotracheal intubation; they are therefore good substitutes for muscle relaxants when used along with intravenous or inhaled hypnotics during intubation (1,2).…”

Section: Introductionmentioning

confidence: 99%

Use of Remifentanil and Alfentanil in Endotracheal Intubation: A Comparative Study

Imani¹,

Faiz²,

Alebouyeh³

et al. 2011

Anesth Pain

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A B S T R A C TBackground: Opioids, such as alfentanil, are used to facilitate endotracheal intubation without the use of neuromuscular blocking agents in patients undergoing elective surgery. Objectives: The goal of this study was to evaluate the endotracheal intubation conditions when remifentanil or alfentanil was used with propofol without the application of neuromuscular blocking agents. Patients and Methods: One hundred American Society of Anesthesiologists (ASA) grade I patients scheduled for elective surgery were enrolled in this prospective, randomized, triple-blinded study. The patients were randomized to group A (alfentanil) or R (remifentanil). In group A, alfentanil (50 mcg/kg) was intravenously injected over 10 seconds, and after 45 seconds or at the occurrence of apnea, propofol (2 mg/kg) was intravenously injected over 5 seconds. Thirty seconds after the administration of propofol, laryngoscopy and endotracheal intubation were attempted. In group R, remifentanil (5 mcg/kg) was administered instead of alfentanil. Intubation conditions, including ease of laryngoscopy, patency of the vocal cords, jaw relaxation, limb movement (1-4 score), and also, demographic data were evaluated. Results: There were no demographic data diffrerences between groups (age, weight, and sex). Further, laryngoscopy, jaw relaxation, and limb movement scores were similar in the R and A groups and there were no significant differences, but vocal cords were significantly more patent in group R than those in group A (P = 0. 028). Conclusions:The results of this study showed that remifentanil, similar to alfentanil, provided excellent conditions for endotracheal intubation when used with propofol for the induction of anesthesia; however, remifentanil improved the patency of the vocal cords to a greater extent than alfentanil.

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Intubation under induction doses of propofol

Cited by 76 publications

References 5 publications

Optimal remifentanil dosage for providing excellent intubating conditions when co‐administered with a single standard dose of propofol

Optimal remifentanil dosage for providing excellent intubating conditions when co‐administered with a single standard dose of propofol

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

Use of Remifentanil and Alfentanil in Endotracheal Intubation: A Comparative Study

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