Tracheal Intubation without the Use of Muscle Relaxants: Remifentanil in Combination with Propofol

Jung, Bong Chan; Lee, Jung Un

Abstract

BACKGROUND: Using alfentanil followed by an anesthetic induction dose of propofol provides adequate conditions for tracheal intubation without neuromuscular blocking drugs in most patients. Providing an option for intense opioid effect without compromising recovery after short operations, remifentanil might offer benefits over alfentanil. In this study intubating conditions after remifentanil-propofol were evaluated.
METHODS
Sixty healthy premedicated patients were divided randomly into 3 groups. Anesthesia was intravenously induced with propofol (4 microgram/ml) followed by remifentanil. Group R(2), R(3), R(4) received 2, 3, 4 microgram/kg remifentanil, respectively. Ninety seconds after the administration of remifentanil, laryngoscopy and intubation were attempted. Intubation conditions were assessed as excellent, good or poor. The hemodynamic changes were measured at preinduction (base), preintubation, postintubation (immediately, 3 minute, 5 minute after intubation).
RESULTS
Clinically acceptable intubating conditions were observed in 65%, 95%, and 95% of patients in the R(2), R(3), and R(4) groups, respectively. Clinically acceptable intubating conditions were significantly (P < 0.05) less likely to occur in Group R(2). The mean arterial pressure decreased immediately after induction in all groups. There was no significant elevation in heart rate after tracheal intubation in all groups. There were no significant differences among groups.
CONCLUSIONS
Healthy, premedicated patients with favorable airway anatomy can be reliably intubated with good or excellent conditions 90 seconds after the administrations of remifentanil 3-4 microgram/kg and propofol.