Comparison of intubating conditions after induction with propofol combined with remifentanil or sufentanil in surgical tooth extraction: a randomized controlled trial

Background The aim of this study was to compare tracheal intubation conditions after anesthetic induction bolus of propofol-sufentanil or propofol-remifentanil. Methods A total of 70 patients, ASA I-II undergoing ambulatory surgery under general anesthesia with intubation for tooth extraction were randomly assigned in this double-blind study. They received either remifentanil (3 μg/kg) or sufentanil (0,3 μg/kg) associated with 2,5 mg/kg of propofol for intubation. Intubating conditions score were compared using the Scandinavian scale. The primary outcome was the comparison of the percentage of excellent intubation conditions. The secondary outcomes were the percentage of patients with a decrease of over 20% in MAP or HR, time to have a spontaneous respiration, time between the end of the surgery and extubation, time to obtain an Aldrete score of 10. The percentage of patients having a pain score>3 or having laryngeal pain 15 minutes after arriving in PACU were also analyzed. Discussion Compared with the sufentanil group, intubating conditions were significantly better in the remifentanil group (51.4% vs. 20%; p=0.0064). When using remifentanil, the hemodynamic conditions were good. Using remifentanil did not increase significantly the pain score or the laryngeal pain in recovery room. This is confirmed by the fact that morphine consumption was not significantly different in the two groups. Injecting remifentanil decreased significantly the time to obtain an Aldrete score of 10. When intubating without muscle relaxants is required, intubating conditions are widely better when remifentanil is used in comparison with sufentanil. Study registration This study was approved by the research ethics board (protocol number 09.001.03, favorable opinion of the CPP Sud-Ouest et Outre-Mer 1 dated January 19, 2011) and written informed consent was obtained from each patient. This trial was registered at ClinicalTrials.gov (NCT01533662).

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