Sevoflurane at 1.0 MAC together with remifentanil and propofol produces clinically acceptable intubation conditions at the vocal cords: A prospective randomized study

• Published in: Journal of international medical research Vol. 45; no. 3; pp. 1098 - 1108
• Main Authors: Ovari, Attila, Bicker, Ilona, Machmueller, Susann, Schuldt, Tobias, Sauer, Martin, Soltesz, Stefan, Noeldge-Schomburg, Gabriele, Mlynski, Robert, Mencke, Thomas
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-06-2017
• Subjects: Adult; Anesthetics, Inhalation - administration & dosage; Clinical Reports; Female; Hoarseness - etiology; Humans; Hypnotics and Sedatives - administration & dosage; Intubation, Intratracheal - adverse effects; Male; Methyl Ethers - administration & dosage; Middle Aged; Pharyngitis - etiology; Piperidines - administration & dosage; Propofol - administration & dosage; Prospective Studies; Vocal Cords - injuries; Sevoflurane; sore throat; intubation conditions; remifentanil; laryngeal injury; sex
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/0300060517701355

Objective
The overall intubation conditions after tracheal intubation with remifentanil, propofol, and sevoflurane at 1.0 minimum alveolar concentration (MAC) are worse than with rocuronium at 0.45 mg/kg. Therefore, we compared the intubation conditions and laryngeal morbidity (vocal cord injuries, hoarseness, and sore throat) with sevoflurane at 1.2 and 1.4 MAC versus 1.0 MAC.
Methods
In this prospective clinical trial, 90 patients were randomized to 3 groups: the sevoflurane 1.0, 1.2, and 1.4 MAC groups. At 3 min, tracheal intubation was performed and the patients’ intubation conditions were assessed. The vocal cords were examined for injury by videolaryngoscopy. Additionally, the incidence and severity of laryngeal morbidity were compared between women and men.
Results
Acceptable intubation conditions were seen in 72% of the patients without significant differences between the groups. Overall, vocal cord injuries (oedema) occurred in three (4%) patients. Women reported sore throat more often than men (51% vs. 21%, respectively).
Conclusions
Intubation conditions were not improved with higher sevoflurane concentrations. The incidence and severity of sore throat were greater in women than men.
Trial registration: ClinicalTrials.Gov: NCT 01896245