Remifentanil without muscle relaxants for intubation in microlaryngoscopy: a double blind randomised clinical trial.

OBJECTIVES We aimed to compare the effect of remifentanil without muscle relaxant with succinylcholine for intubation in microlaryngoscopy. PATIENTS AND METHODS Eighty patients were randomly divided into two groups: Group R (n=40) and S (n=40) received remifentanil 4 µg/kg intravenously or 1 µg/kg respectively. Anesthesia was induced with 2 mg/kg propofol in both groups. Intubation was performed after bolus administration of 10 ml saline as a placebo or 1 mg/kg of succinylcholine in Group R and S respectively. Remifentanil infusion was initiated at 0.025 μg/kg in each groups. RESULTS Intubation conditions were similar in both groups. The mean arterial pressure (MAP) values at post-induction period were significantly lower in the Group S than in the Group R (p = 0.001). The requirement for ephedrine in Group R was found to be significantly lower than Group S (p = 0.023). Recovery times were significantly shorter (p = 0.001) and recovery scores were significantly higher (p = 0.021) in Group R. Time to patient could respond to commands was significantly longer in the Group S (p = 0.001). The surgeon's satisfaction score was significantly higher in Group R (p = 0.001). CONCLUSIONS It was concluded that remifentanil without muscle relaxants provides similar intubating conditions as that provided by succinylcholine, and remifentanil is superior to succinylcholine with regard to haemodynamic stability and recovery duration.

[1]  Anil D. Patel,et al.  Anesthesia for Eye, Ear, Nose, and Throat Surgery , 2010 .

[2]  A. Sia,et al.  Tracheal intubating conditions using propofol and remifentanil target-controlled infusion: a comparison of remifentanil EC50 for Glidescope and Macintosh , 2009, European journal of anaesthesiology.

[3]  K. Posner,et al.  The Hunsaker Mon-Jet tube with jet ventilation is effective for microlaryngeal surgery , 2009, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[4]  E. Kochs,et al.  Early recovery after remifentanil-pronounced compared with propofol-pronounced total intravenous anaesthesia for short painful procedures. , 2003, British Journal of Anaesthesia.

[5]  E. Erhan,et al.  Tracheal intubation without muscle relaxants: remifentanil or alfentanil in combination with propofol , 2003, European journal of anaesthesiology.

[6]  P. Glass,et al.  Assessment of Depth of Anesthesia and Postoperative Respiratory Recovery after Remifentanil-versus Alfentanil-based Total Intravenous Anesthesia in Patients Undergoing Ear–Nose–Throat Surgery , 2001, Anesthesiology.

[7]  I. Russell,et al.  Comparison of intubating conditions following propofol and succinylcholine with propofol and remifentanil 2 μg kg−1 or 4 μg kg−1 , 2000 .

[8]  I. Matot,et al.  The Effect of Clonidine Premedication on Hemodynamic Responses to Microlaryngoscopy and Rigid Bronchoscopy , 2000, Anesthesia and analgesia.

[9]  L. Saarnivaara,et al.  Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol , 2000, Acta anaesthesiologica Scandinavica.

[10]  P. Glass,et al.  Comparison of remifentanil with alfentanil or suxamethonium following propofol anaesthesia for tracheal intubation , 1999, Anaesthesia.

[11]  F. Servin,et al.  Remifentanil as an analgesic adjunct in local/regional anesthesia and in monitored anesthesia care. , 1999, Anesthesia and analgesia.

[12]  Stuart A. Grant,et al.  Duration of apnoea with two different intubating doses of remifentanil. , 1999, European journal of anaesthesiology.

[13]  Stuart A. Grant,et al.  Tracheal intubating conditions after induction with propofol, remifentanil and lignocaine. , 1998, European journal of anaesthesiology.

[14]  J. Stevens,et al.  Tracheal Intubation in Ambulatory Surgery Patients: Using Remifentanil and Propofol Without Muscle Relaxants , 1998, Anesthesia and analgesia.

[15]  H. Van Aken,et al.  Remifentanil: A Novel, Short-Acting, mu-Opioid , 1996, Anesthesia and analgesia.

[16]  David J. Hermann,et al.  The Pharmacokinetics of the New Short‐acting Opioid Remifentanil (GI87084B) in Healthy Adult Male Volunteers , 1993, Anesthesiology.

[17]  C. Quinn,et al.  Comparative trial of succinylcholine vs low dose atracurium-lidocaine combination for intubation in short outpatient procedures. , 1990, Anesthesia progress.

[18]  O. Ravlo,et al.  The influence of alfentanil on the intubating conditions after priming with vecuronium , 1988, Acta anaesthesiologica Scandinavica.

[19]  J. Caprioli.  Anesthesia for Eye, Ear, Nose and Throat Surgery , 1987 .

[20]  E. D. VAN TINE,et al.  Anesthesia for eye, ear, nose and throat surgery. , 1946, Hahnemann monthly.