TRACHEA! INTUBATION

COMPARISON BY USING THIOPENTOL AND VARYING DOSES OF REMIFENTANIL, WITHOUT MUSCLE RELAXANTS.

Abstract

Background: Administration of remifentanil followed by thiopental provides adequate conditions for tracheal intubation without muscle relaxants. However, controversy still remains on the best dose of remifentanil. Objectives: To identify the optimum dose of remifentanil in which the best intubating conditions could be achieved. Design: prospective randomized double biind clinical trial Period: From June 2004 to November 2005. Material & Methods: In a randomized, double blind study, 90 ASA I or II patients were randomly divided into three equal groups (n=30). Intubating
condition and hemodynamic changes were assessed after injection of remifentanil 2.0 pg/kg (group A), 3.0 (jg/kg (group B) and 4.0 (jg/kg (group C). This was followed by thiopental 5mg/kg. Ninety seconds after administration of the hypnotic agent, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, satisfactory, fair or unsatisfactory on the basis of ease of ventilation, jaw relaxation, position of the vocal cords, and patient response to intubation and slow inflation of the endotracheal tube cuff. Hemodynamic changes were recorded at baseline, 1 min after induction, 1, 3 and 5 minutes after intubation. Results: Excellent intubating conditions were observed in 13.3% (n= 4), 46.7%
(n=14), 83.3% (n=25) of patients in Groups A, B and C, respectively. Overall conditions at intubation were significantly (P<0.05) higher with 4pg/kg remifentanil compared with other doses. Conclusion: Intubation conditions were best when using thiopental 5 mg/kg combined with remifentanil at 4 mg/kg and no muscle relaxant.