Tracheal Intubation After Induction of Anaesthesia With Profol, Alfentanil and I.V. Lignocaine

Davidson, J. A. H.; Gillespie, J. A.

doi:10.1093/bja/70.2.163

Cited by 106 publications

(58 citation statements)

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“…We also found that propofol and fentanyl alone also provided unacceptable intubating conditions at 60 s in all patients, with a failure rate of 30% at the first attempt. Propofol has been shown in some studies to provide acceptable intubating conditions without the use of muscle relaxants; however, this is usually in combination with alfentanil and/or lignocaine, and not in a rapid-sequence induction technique [9,10]. Beck et al [11] claimed that propofol and alfentanil provided a satisfactory alternative to thiopentone and suxamethonium for a rapid-sequence induction; however, they did not apply cricoid pressure and used a fairly large dose of 50 mg.kg ¹1 of alfentanil.…”

Section: Discussionmentioning

confidence: 99%

Comparison of sevoflurane and propofol with rocuronium for modified rapid‐sequence induction of anaesthesia

et al. 1999

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SummaryWe compared the use of sevoflurane and propofol with three different doses of rocuronium for modified rapid-sequence induction of anaesthesia. One hundred and forty adult patients were randomly allocated to have a rapid-sequence intravenous induction with propofol 2-3 mg.kg ¹1 (group P) or an inhalational induction with sevoflurane 8% in oxygen, using a vital capacity technique (group S). Following loss of the eyelash reflex, cricoid pressure was applied and 20 patients in each group were administered rocuronium 0.3 (groups P/0.3 and S/0.3), 0.45 (groups P/0.45 and S/0.45) or 0.6 (groups P/0.6 and S/0.6) mg.kg ¹1. An additional 10 patients in each group received only saline placebo in place of the muscle relaxant (groups P/Saline and S/Saline). Laryngoscopy was started 60 s later and intubating conditions evaluated by a blinded anaesthetist according to a standard scoring system. Intubating conditions were acceptable in one patient and no patient, respectively, following induction with sevoflurane and propofol without the muscle relaxant. The conditions were acceptable in 30, 55 and 90% of subjects with sevoflurane induction, and in 45, 80 and 90% of subjects with propofol induction following 0.3, 0.45 and 0.6 mg.kg ¹1 of rocuronium, respectively (no significant difference for each dose of rocuronium). The present study shows that intubating conditions during a rapid-sequence induction using rocuronium 0.6 mg.kg ¹1 following induction of anaesthesia with sevoflurane or propofol are similar.

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Section: Discussionmentioning

confidence: 99%

Comparison of sevoflurane and propofol with rocuronium for modified rapid‐sequence induction of anaesthesia

et al. 1999

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“…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). Previous studies have examined the use of alfentanil for endotracheal intubation in children and adults without the use of muscle relaxants (5)(6)(7)(8)(9)(10). Remifentanil is an ultra-short-acting opioid resulting in short-term complications (11-13).…”

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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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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. However, additional administration of muscle relaxants improves visibility and success rate but comes at a price -myalgia.…”

Section: Discussionmentioning

confidence: 99%

Tracheal intubation of outpatients with and without muscle relaxants

Collins

Prentice

Vaghadia

2000

Can J Anesth/J Can Anesth

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Purpose: To compare intubating conditions and postoperative myalgias in outpatients after intubation with propofol/alfentanil compared with propofol/alfentanil/succinylcholine with and without precurarisation with d-tubocurarine.Methods: 144 ASA I -II ambulatory patients for dental extraction under anesthesia were studied. Subjects received either 3mg d-tubocurarine (Group II) or saline (Groups I, III) iv prior to induction of anesthesia with 20 µg·kg -1 alfentanil and 2.5 mg·kg propofol followed by 1.5 mg·kg -1 succinylcholine (II and III) or saline 0.9% (I) for muscle relaxation. The ease of airway management and the postoperative incidence, severity and distribution of muscle pains were examined.Results: Intubation was successful in all patients and there were no differences in jaw mobility, ease of bag-mask ventilation, visualization of the vocal cords or cord position. Limb movement was more common during intubation in Group I (37.5%) than in Group III (8.3%) or Group II (2%), P < 0.05. At home, VAS scores for myalgia were higher in Group III than in Group I and II. Neck myalgia was more common in Group III (72%) than in Groups II (44%) and I (41%), P < 0.05. Myalgias were also more common in Group III patients (P < 0.05).Conclusion: Acceptable intubating conditions were achieved with propofol and alfentanil alone. Succinylcholine reduced limb movement during intubation but was associated with postoperative myalgias for up to five days. Precurarisation with tubocurarine reduced the severity of succinylcholine myalgia. Résultats : L'intubation a réussi chez tous les patients. Il n'y a pas eu de différence concernant la mobilité de la mâchoire, la facilité de ventilation au masque, la visualisation des cordes vocales ou leur position. Les mouvements des membres étaient plus fréquents à l'intubation chez les patients du Groupe I (37,5 %) que des Groupes III (8,3 %) et II (2 %), P < 0,05. Après le congé, les scores de myalgie à l'EVA étaient plus hauts dans le Groupe III que dans les Groupes I et II. La myalgie du cou a été plus fréquente dans le Groupe III (72 %) que dans les Groupes II (44 %) et I (41 %), P < 0,05. Les myalgies ont été aussi plus fréquentes dans le Groupe III ( P < 0,05).Conclusion : L'emploi de propofol / alfentanil seul a permis des conditions d'intubation acceptables. La succinylcholine a diminué les mouvements des membres pendant l'intubation, mais a été associée à des myalgies jusqu'à cinq jours après l'opération. La précurarisation avec la tubocurarine a réduit la sévérité de la myalgie reliée à la succinylcholine.

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Tracheal Intubation After Induction of Anaesthesia With Profol, Alfentanil and I.V. Lignocaine

Cited by 106 publications

References 0 publications

Comparison of sevoflurane and propofol with rocuronium for modified rapid‐sequence induction of anaesthesia

Comparison of sevoflurane and propofol with rocuronium for modified rapid‐sequence induction of anaesthesia

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

Tracheal intubation of outpatients with and without muscle relaxants

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