Tracheal Intubation Using Alfentanil and No Muscle Relaxant

Abstract

Administration of alfentanil followed by propofol intravenously (IV) without neuromuscular blockade for induction of anesthesia provides adequate conditions for tracheal intubation. Other hypnotic drugs have not been thoroughly investigated in this regard. Accordingly, 140 ASA physical status I and II premedicated outpatients were randomly assigned to one of seven groups (n = 20/group). Patients in Groups I-VI received alfentanil 40 microg/kg followed by etomidate 0.3 mg/kg, propofol 2 mg/kg, or thiopental 4 mg/kg. One half of these patients (Groups II, IV, VI) also received lidocaine 1 mg/kg IV prior to the administration of the above drugs. Patients in group VII received d-tubocurarine 3 mg followed by thiopental 4 mg/kg and succinylcholine 1 mg/kg. Ninety seconds after induction, laryngoscopy and endotracheal intubation were attempted and graded. Patients in Group V (alfentanil/thiopental) were significantly (P < 0.05) more likely to have a clinically unacceptable response to intubation (55%) (e.g., vigorous coughing, purposeful movement, or requirement for succinylcholine to complete intubation) compared with patients who received propofol (35%) or etomidate (20%). Alfentanil/etomidate yielded intubation conditions comparable to those achieved with alfentanil/propofol and d-tubocurarine/thiopental/succinylcholine. Lidocaine appeared to improve intubating conditions, although this improvement did not reach statistical significance. The results suggest that healthy, premedicated patients with favorable airway anatomy who have received alfentanil 40 microg/kg can be reliably tracheally intubated 90 s after administration of propofol 2 mg/kg or etomidate 0.3 mg/kg.

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

“…Remifentanil administration (1 to 3 mcg/kg) without propofol can lead to muscle stiffness (i. e. , difficult ventilation with a mask) depending on the drug dosage and the speed of administration ( 12 , 13 ), but if administered in combination with propofol, muscle stiffness will rarely occur ( 20 ). Similarly, alfentanil (40 mcg/kg) in combination with propofol does not lead to significant muscle stiffness ( 8 , 9 ).…”

A comparison of haemodynamic responses between clinical assessment-guided tracheal intubation and neuromuscular block monitoring-guided tracheal intubation: A prospective, randomised study

“…The laryngoscopy and subsequent endotracheal intubation induce strong nociceptive stimuli resulting numerous responses for example, motor response, characteristic electroencephalographic evidence of central nervous system stimulation or stimulation of the sympathetic nervous system manifested by increased arterial pressure and accelerated HR. [ 11 12 ] In our study, patients intubated by clinical judgment showed higher mean values of mean arterial pressure and HR during and after intubation in comparison to the patients who were intubated under guidance of neuromuscular monitoring ( P < 0.05). It seems that in patients with incomplete neuromuscular block, laryngoscopy and intubation cause stronger nociceptive stimulation, hence a stronger reflex cardiovascular reaction.…”

Comparing the effects of three different additional doses of propofol infusion on intubation condition and hemodynamic changes during general anesthesia under elective surgery: A randomized, placebo-controlled, double blind clinical trial

“…In this study, laryngoscopy was performed 7 min after fentanyl injection, as some authors have described that the peak action of fentanyl comes after 7 min. [1314] However, in many studies as our study laryngoscopy was performed earlier. Kwon et al .…”