Tracheal Intubating Conditions and Hemodynamic Change in Ambulatory Surgery: Propofol and Remifentanil Target Controlled Infusions with Low Dose Rocuronium

Kim, Jong Yeop; Kim, Jae Hyung; Park, Sung Yong; Lee, Hyun Ho

Abstract

BACKGROUND: This study evaluated the tracheal intubating conditions and hemodynamic changes in tracheal intubation according to the different effect-site concentrations of remifentanil combined with a target controlled infusion (TCI) of propofol using low dose rocuronium.
METHODS
Forty-five patients presenting for ambulatory surgery were randomly assigned to one of three groups according to the target effect-site concentration of remifentanil: 2.5 ng/ml (group R2.5), 3.0 ng/ml (group R3.0), 3.5 ng/ml (group R3.5). After midazolam administration, anesthesia was induced using a target effect-site controlled infusion of propofol 4.0microgram/ml, which was then reduced to 2.5microgram/ml. At the same time, a TCI of remifentanil was started. A neuromuscular blockade was produced by rocuronium 0.4 mg/kg. The trachea was intubated 4 min after induction. The tracheal intubation conditions were assessed using a standard scoring system. The noninvasive arterial blood pressure, heart rate (HR), and bispectral index were recorded at 1 min intervals from the start of induction to 5 min after intubation.
RESULTS
Intubation was successful in all patients except for one in the R2.5 group. The number of excellent intubating conditions was significantly higher in the R3.5 group (12/15) than in the R2.5 group (6/15) (P < 0.05). The mean arterial pressure (MAP) in the R2.5 and R3.0 groups increased significantly at 1 min after intubation (P < 0.05), but the MAP in the R3.5 group increased slightly at 1 min after intubation.
CONCLUSIONS
The effect-site concentration of remifentanil 3.5 ng/ml combined with a TCI of propofol using rocuronium 0.4 mg/kg provides the most adequate intubating conditions and hemodynamic stability.