Bolus dose remifentanil for control of haemodynamic response to tracheal intubation during rapid sequence induction of anaesthesia

Abstract

The effect of three bolus doses of remifentanil on the pressor response to laryngoscopy and tracheal intubation during rapid sequence induction of anaesthesia was assessed in a randomized, double-blind, placebo-controlled study in four groups of 20 patients each. After preoxygenation, anaesthesia was induced with thiopental 5-7 mg kg-1 followed immediately by saline (placebo) or remifentanil 0.5, 1.0 or 1.25 micrograms kg-1 given as a bolus over 30 s. Cricoid pressure was applied just after loss of consciousness. Succinylcholine 1 mg kg-1 was given for neuromuscular block. Laryngoscopy and tracheal intubation were performed 1 min later. Arterial pressure and heart rate were recorded at intervals until 5 min after intubation. Remifentanil 0.5 microgram kg-1 was ineffective in controlling the increase in heart rate and arterial pressure after intubation but the 1.0 and 1.25 micrograms kg-1 doses were effective in controlling the response. The use of the 1.25 micrograms kg-1 dose was however, associated with a decrease in systolic arterial pressure to less than 90 mm Hg in seven of 20 patients.

Scandinavian clinical practice guidelines on general anaesthesia for emergency situations

“…Given before succinylcholine 1 mg/kg and tracheal intubation, the dose of remifentanil seems to be similar both in combination with propofol 2 mg/kg 125 and in combination with thiopentone 5-7 mg/kg. 126 However, 35% of patients receiving the 1.25 mg/ kg dose of remifentanil had hypotensive episodes at some time during the study. 126 In hypertensive patients, using thiopentone 5-7 mg/kg for induction, remifentanil 1 mg/kg was a better adjunct for attenuation of the response to laryngoscopy than lidocaine 1.5 mg/kg 127 [II].…”

“…126 However, 35% of patients receiving the 1.25 mg/ kg dose of remifentanil had hypotensive episodes at some time during the study. 126 In hypertensive patients, using thiopentone 5-7 mg/kg for induction, remifentanil 1 mg/kg was a better adjunct for attenuation of the response to laryngoscopy than lidocaine 1.5 mg/kg 127 [II]. In the same study, it was concluded that the combination of remifentanil 1 mg/kg and succinylcholine 1 mg/kg was more beneficial in terms of haemodynamic stability in comparison with remifentanil 1 mg/kg and rocuronium 1 mg/kg.…”

“…Two studies indicate that remifentanil 1-1.25 mg/ kg intravenously effectively blunts the haemodynamic responses to intubation 125,126 [II]. Given before succinylcholine 1 mg/kg and tracheal intubation, the dose of remifentanil seems to be similar both in combination with propofol 2 mg/kg 125 and in combination with thiopentone 5-7 mg/kg.…”

The McGrath Series 5 video laryngoscope versus the Macintosh laryngoscope: a randomized trial in obstetric patients

“…In addition, a recent study showed that intubation times with video laryngoscopes can be decreased with proper preparation of the stylet and tracheal tube (7,27 Various studies indicated that laryngoscopy may cause an undesirable increase in blood pressure and heart rate in anesthetized patients (29)(30)(31)(32)(33)(34)(35). Various video laryngoscopes have been studied to elucidate the hemodynamic changes during orotracheal intubation; however, there has been no study comparing the hemodynamic response to orotracheal intubation of the McGrath Series 5 video laryngoscope and the Macintosh laryngoscope (36)(37)(38)(39). Moreover, in one study, Jeon et al reported that the McGrath video laryngoscope led to a significant increase in systolic arterial blood pressure and heart rate compared to baseline (14).…”

Anaesthetic management of pregnancy complicated by a symptomatic arachnoid cyst

“…Remifentanil has been shown to control haemodynamic responses following rapid sequence induction and is expected not to have any significant effect on the neonate because of its rapid metabolism. 3,4 Lidocaine spray was also applied to the vocal cords before intubation in order to blunt the hypertensive response to laryngoscopy. Thirdly, following surgical closure of the wound a bilateral TAP block was performed for supplemental analgesia.…”