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Propofol — not thiopental or etomidate — with remifentanil provides adequate intubating conditions in the absence of neuromuscular blockade

Le propofol, mais non le thiopental ou l’étomidate, combiné au rémifentanil, permet des conditions d’intubation satisfaisantes en l’absence de blocage neuromusculaire

Abstract

Purpose

Administration of remifentanii followed by propofol provides adequate conditions for tracheal intubation without muscle relaxants. Other hypnotic drugs have not been thoroughly investigated in this regard. Intubating conditions with remifentanil followed by propofol, thiopentone or etomidate are compared in this study.

Methods

In a randomized, double-blind study 45 healthy males were assigned to one of three groups (n = 15). After iv atropine, remifentanil 3 μg· kg−1 were injected over 90 sec followed by propofol 2 mg· kg−1 (Group I), thiopentone 6 mg· kg−1 (Group II) or etomidate 0.3 mg· kg−1 (Group III), Ninety seconds after the administration of the hypnotic agent, laryngoscopy and intubation were attempted, Intubating conditions were assessed as excellent, good or poor on the basis of ease of ventilation, jaw relaxation, position of the vocal cords, and patient response to intubation and slow inflation of the endotracheal tube cuff.

Results

One patient in Group I, three patients in Group II and five patients in Group III could not be intubated on the first attempt. Clinically acceptable intubating conditions were observed in 93.3%, 66.7%, 40.0% of patients in Groups I, II and III, respectively. Overall conditions at intubation were significantly (P < 0,05) better, and the frequency of excellent conditions was significantly (P < 0.05) higher in the propofol group compared with the thiopentone and etomidate groups. No patient was treated for hypotension or bradycardia.

Conclusion

Propofol 2 mg· kg−1 was superior to thiopentone 6 mg· kg−1 and etomidate 0.3 mg· kg−1 for tracheal intubation when combined with remifentanil 3 μg· kg−1 and no muscle relaxant.

Résumé

Objectif

L’administration de rémifentanil suivie de propofol permet des conditions satisfaisantes d’intubation endotrachéale sans myorelaxants. D’autres hypnotiques n’ont pas encore été testés dans ces circonstances. Nous avons donc voulu comparé les conditions d’intubation avec le rémifentanil suivi du propofol, du thiopental ou de l’étomidate.

Méthode

L’étude randomisée et à double insu a été réalisée auprès de 45 hommes en bonne santé, répartis en trois groupes (n = 15). Après l’administration iv d’atropine, l’injection de 3 μg· kg−1 de rémifentanil, pendant 90 sec, a été suivie de 2 mg· kg−1 de propofol (Groupe I), de 6 mg· kg−1 de thiopentai (Groupe II) ou de 0,3 mg· kg−1 d’étomidate (Groupe III). Quatre-vingt-dix secondes après l’administration de l’agent hypnotique, la laryngoscope et l’intubation ont été tentées. Les conditions d’intubation ont été évaluées comme excellentes, bonnes ou pauvres d’après la facilité de ventilation, du relâchement de la mâchoire, la position des cordes vocales et la réponse du patient à l’intubation et au gonflement lent du ballonnet du tube endotrachéal.

Résultats

Un patient du Groupe I, trois du Groupe II et cinq du Groupe III n’ont pu être intubés au premier essai. Des conditions d’intubation acceptables ont été observées chez 93,3 %, 66,7 % et 40,0 % des patients des Groupes I, II et III. Dans l’ensembie, les conditions d’intubation ont été signifiativement (P < 0,05) meilleures, et la fréquence de conditions excellentes a été signifeativement (P < 0,05) plus élevée, avec le propofol, comparé au thiopentai et à l’étomidate. Aucun patient n’a dû recevoir de traitement pour hypotension ou bradycardie.

Conclusion

Les conditions d’intubation endotrachéale ont été meilleures avec l’usage de 2 mg· kg−1 de propofoi, comparés à 6 mg· kg−1 de thiopental et à 0,3 mg· kg−1 d’étomidate, combinés à 3 μg· kg−1de remifentanil et sans myorelaxants.

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Correspondence to Elvan Erhan.

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Erhan, E., Ugur, G., Gunusen, I. et al. Propofol — not thiopental or etomidate — with remifentanil provides adequate intubating conditions in the absence of neuromuscular blockade. Can J Anaesth 50, 108 (2003). https://doi.org/10.1007/BF03017840

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Keywords

  • Mean Arterial Pressure
  • Muscle Relaxant
  • Tracheal Intubation
  • Vocal Cord
  • Remifentanil