The best method was the combination of remifentanil 4 microg kg(-1) and propofol 2.5 mg kg(-1). This provided satisfactory intubating conditions in 93%, and prevented cardiovascular intubation response.

In a double-blind, randomized study, we have compared the efficacy of transdermal hyoscine in the prevention of nausea and vomiting with placebo in 60 young, ASA I-II patients after middle ear surgery during general anaesthesia. In the placebo group, 27% and 43% of patients suffered from nausea and vomiting, respectively, during the first 24 h after anaesthesia. The corresponding values for both symptoms in the hyoscine group were 10% (P < 0.001 between groups). The frequency of side effects was similar in both groups. The results suggest that transdermal hyoscine is a useful prophylaxis against nausea and vomiting after middle ear surgery.

Purpose: To compare the intubating conditions after remifentanil-propofol with those after propofol-rocuronium combination with the aim of determining the optimal dose of remifentanil.Methods: In a randomized, double-blind study 80 healthy children aged three to nine years were assigned to one of four groups (n=20): 2 or 4 µg·kg -1 remifentanil (Re2 or Re4); 2 µg·kg -1 remifentanil and 0.2 mg·kg -1 rocuronium (Re2-Ro0.2); 0.4 mg·kg -1 rocuronium (Ro0.4). After atropine, remifentanil was injected over 30 sec followed by 3.5 mg·kg -1 propofol and rocuronium. After 60 sec, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor based on ease of ventilation, jaw relaxation, position of the vocal cords, and coughing to intubation.Results: In all children intubation was successful. Overall intubating conditions were better (P < 0.01), and the frequency of excellent conditions, 85%, was higher (P < 0.01) in the Re4 group than in the Ro0.4 group. No child manifested signs of muscular rigidity. In the remifentanil groups, arterial pressure decreased 11-13% and heart rate 6-9% after anesthetic induction, and remained at that level throughout the study. Conclusion:The best intubating conditions were produced by the combination of 4 µg·kg -1 remifentanil and 3.5 mg·kg -1 propofol. It provided excellent or good intubating conditions in all children without causing undue cardiovascular depression.Objectif : Comparer les conditions d'intubation après l'usage d'une combinaison de rémifentanil-propofol avec celles d'une combinaison de propofol-rocuronium dans le but de déterminer la dose optimale de rémifentanil.Méthode : Lors d'une étude randomisée et à double insu, 80 enfants en bonne santé, de trois à neuf ans, ont été répartis en quatre groupes (n=20) et ont reçu : 2 ou 4 µg·kg -1 de rémifentanil (Ré2 ou Ré4); 2 µg·kg -1 de rémifentanil et 0,2 mg·kg -1 de rocuronium (Ré2-Ro0,2); 0,4 mg·kg -1 de rocuronium. Après l'administration d'atropine, le rémifentanil a été injecté pendant 30 s et a été suivi de 3,5 mg·kg -1 de propofol et de rocuronium. La laryngoscopie et l'intubation ont été tentées après 60 s. Les conditions d'intubation ont été évaluées comme excellentes, bonnes ou pauvres selon la facilité de la ventilation, la relaxation de la mâchoire, la position des cordes vocales et la toux pendant l'intubation.Résultats : L'intubation a été réussie chez tous les enfants. Les conditions générales d'intubation ont été meilleures (P < 0,01), et la fréquence d'excellentes conditions, 85 %, plus élevée (P < 0,01) dans le groupe Ré4 que dans le groupe Ro0,4. Aucun enfant n'a manifesté de signe de rigidité musculaire. Dans les groupes rémifen-tanil, la tension artérielle a baissé de 11-13 % et la fréquence cardiaque de 6-9 % après l'induction de l'anesthésie et sont demeurées à ce niveau tout au long de l'étude. Conclusion :Les meilleures conditions d'intubation ont été réalisées avec la combinaison de 4 µg·kg -1 de rémifentanil et de 3,5 mg·kg -1 de propofol. L'intubation a été bo...

In a double-blind study, propofol (P) 2-2.5 mg.kg-1 preceded by saline (Sal) or alfentanil (A) 20-30 micrograms.kg-1 was used for anaesthetic induction in 59 young patients of ASA physical class I or II, premedicated with oxycodone 0.1 mg.kg-1 and atropine 0.01 mg.kg-1 i.m. The patients were randomly allocated to one of the four groups: Group 1 Sal + P2.5, Group 2 A20 + P2.5, Group 3 A30 + P2.5 and Group 4 A30 + P2. Pain on injection of propofol occurred in 67, 36 and 7% of the patients in the Sal + P2.5, A20 + P2.5 and A30 + P2 groups, respectively, but not at all in the A30 + P2.5 group. Intubating conditions were assessed as good, moderate, poor or impossible on the basis of jaw relaxation, ease of insertion of the tube and coughing on intubation, each on a three-point scale. In impossible cases, suxamethonium was used. In the Sal + P2.5 group, the frequencies of good, moderate, poor and impossible intubating conditions were 0, 38, 8 and 54%, respectively. The corresponding figures in the A30 + P2.5 group were 43, 46, 7 and 14% (P less than 0.05 between the groups). The other groups did not differ significantly from the Sal + P2.5 group. After injection of propofol, both systolic and diastolic arterial pressures decreased significantly in all other groups, with the exception of diastolic pressure in the Sal + P2.5 group, whereas heart rate did not differ from the control level. After intubation, systolic arterial pressure increased statistically significantly in the Sal + P2.5 and A30 + P2 groups and diastolic arterial pressure in all other groups with the exception of the A30 + P2.5 group when compared with the corresponding preceding values.(ABSTRACT TRUNCATED AT 250 WORDS)

The effects of propofol 2 mg/kg, methohexital 2 mg/kg or midazolam 0.3 mg/kg were studied on the QT interval of the ECG corrected by the heart rate (QTc), heart rate and arterial pressure during induction of anaesthesia in 87 ASA class I-(II)-patients. The patients were randomly allocated to one of the three anaesthetic groups. The incidence of the patients with a prolonged QTc interval (= more than 440 ms) ranged from 29 to 41% between the groups. In each group these patients were treated separately. After all anaesthetics, the QTc interval was significantly prolonged in the patients with a normal control QTc interval, whereas in the patients with a prolonged control QTc interval, it tended to be shortened both after propofol and methohexital and it was significantly shortened after midazolam. After injection of suxamethonium, no significant QTc interval changes occurred in the patients with a normal control QTc interval in either the propofol or the methohexital groups, whereas in the patients with a prolonged control QTc interval treated with propofol the QTc interval decreased significantly 60 s after suxamethonium when compared with the corresponding preceding values. The mean values in the propofol group in the patients with a normal control QTc interval were always below the upper limit of the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)