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

Abstract

Background: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 differences 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.

Endotracheal Intubation Without Neuromuscular Blocking Agents: Is It a Good and Safe Option?

“…We read with great interest the article, "Use of Remifentanil and Alfentanil in Endotracheal Intubation: A Comparative Study," by Imani et al (1). The authors demonstrated that remifentanil in combination with propofol provides excellent conditions for endotracheal intubation in young, healthy patients to avoid the use of muscle relaxants.…”

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

“…I read the paper by Imani et al (1) with interest and must congratulate them in attempting to show the advantages of administering remifentanil for laryngoscopy and tracheal intubation in adult patients. It was interesting to know the experiences of colleagues with regard to tracheal intubation in noncardiac patients, as I use a combination of remifentanil and propofol in my daily practice in cardiac anesthesia.…”

Tracheal Intubation Without Use of Muscle Relaxants: Comparison of Remifentanil and Alfentanil

“…Remifentanil is 20 to 30 times more potent than alfentanil and its elimination half life is 3.8-8.3 minutes. Compared to alfentanil, remifentanil's effect reduces much more quickly after intubation; this is an important advantage over alfentanil, especially in short-term and outpatient surgeries (1,3,6).…”

“…In a related study, Mohammadreza et al (9) In a related study, Imani et al (1) reported better intubation conditions with the combination of 5 µg/kg of remifentanil with 2 mg/kg of propofol than with 2 mg/kg of propofol, 50 µg/kg alfentanil, and 5 µg/kg of remifentanil. Nonhomogeneous distribution of doses, administration speed of agents, injection durations, time elapsed between injection and intubation, different scoring systems used for evaluation of intubation conditions, and age intervals of the cases enrolled in the studies all lead to difficulties in comparing these studies (1,(6)(7)(8)(9)(10). Some limitations are also present with Imani et al's study.…”

“…Using non-depolarizing muscle relaxants may produce prolonged neuromuscular blockade, potentiate histamine release, increase the side effects from anticholinesterases used for reversing the agents, and lead to an inability to quickly reverse the blockade in the event of an unexpected difficult intubation. When using muscle relaxants is undesirable or contraindicated, it is important to administer other, proper induction agents to provide good intubating conditions (1,2). Studies have investigated the use of propofol alone and propofol combined with other drugs (usually fentanyl, alfentanil, or remifentanil) for intubation without using a neuromuscular blockade; the findings have shown that intubation with all of these methods were successful (1-3).…”