Remifentanil With Thiopental for Tracheal Intubation Without Muscle Relaxants

• Published in: Anesthesia and analgesia Vol. 96; no. 5; pp. 1336 - 1339
• Main Authors: Durmus, Mahmut, Ender, Gedik, Kadir, But A., Nurcin, Gulhas, Erdogan, Ozturk, Ersoy, M. Ozcan
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01-05-2003; Lippincott
• Subjects: Adolescent; Adult; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Intravenous; Biological and medical sciences; Blood Pressure - physiology; Dose-Response Relationship, Drug; Double-Blind Method; Female; General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation; Heart Rate - physiology; Humans; Intubation, Intratracheal - methods; Male; Medical sciences; Middle Aged; Muscle Relaxants, Central; Piperidines; Preanesthetic Medication; Prospective Studies; Remifentanil; Thiopental; Human; Thiopental sodium; General anesthesia; Opiates; Narcotic analgesic; Posology; Remifentanil; Dose activity relation; General anesthetic; Surgery; Ambulatory; Intubation; Barbiturates; Trachea
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ANE.0000061222.81081.71

Tracheal intubation may be accomplished with remifentanil and a non-opioid IV anesthetic without a muscle relaxant. In this study, we evaluated in double-blinded, prospective, randomized manner the dose requirements for remifentanil with thiopental without muscle relaxant administration to obtain clinically acceptable intubation conditions and cardiovascular responses. After premedication with midazolam 0.03 mg/kg IV, 105 patients were randomized equally to one of three study groups, each receiving the followingremifentanil 2 μg/kg (Group I), 3 μg/kg (Group II), and 4 μg/kg (Group III). Remifentanil was administered over 30 s, and anesthesia was induced with thiopental 5 mg/kg. Tracheal intubation conditions were assessed by the anesthesiologist performing the intubation as(a) excellent, (b) satisfactory, (c) fair, and (d) unsatisfactory. There were no statistically significant differences among groups regarding to demographic data. Blood pressure and heart rate did not increase in any group after accomplishing intubation. There was a significant improvement in intubation conditions between Groups I and II, I and III, and II and III (P < 0.001). We conclude that remifentanil 4 μg/kg administered before thiopental 5 mg/kg provided excellent or satisfactory intubation conditions in 94% of patients and prevented cardiovascular responses to intubation.