Hemoglobin Desaturation After Propofol/Remifentanil-Induced Apnea

Stefanutto, Tiscia B.; Feiner, John; Krombach, Jens; Brown, Ronald C.; Caldwell, James E.

doi:10.1213/ane.0b013e31824e5bc4

Cited by 16 publications

(8 citation statements)

References 19 publications

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“…Combining propofol with remifentanil, 1.0 to 4.0 μg·kg -1 provided acceptable intubating conditions [1,2,4,17]. Remifentanil 2 μg·kg -1 and propofol 2.0 mg·kg -1 were sufficient to obtain excellent intubating conditions in 11 of 12 healthy volunteers [17].…”

Section: Discussionmentioning

confidence: 99%

“…Remifentanil 2 μg·kg -1 and propofol 2.0 mg·kg -1 were sufficient to obtain excellent intubating conditions in 11 of 12 healthy volunteers [17]. The drugs were given over 5 to 10 seconds, the propofol immediately after the remifentanil, a method which is safe in healthy volunteers or young patients, but not for patients of ASA grade II or III.…”

Section: Discussionmentioning

confidence: 99%

“…Without rocuronium, there was more hoarseness and intubating conditions were worse [17]. Nevertheless, Bouvet et al showed that propofol and remifentanil were associated with a similar incidence of hoarseness and vocal cord injuries to cisatracurium [29], although fibroscopic examination was done 48 hours after surgery only in patients with persisted hoarseness; moreover, small tubes with an ID of 6.5 or 7.0 mm were used [29].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial

et al. 2014

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BackgroundTracheal intubation without muscle relaxants is usually performed with remifentanil and propofol or sevoflurane. Remifentanil 1.0 to 4.0 μg·kg-1 and propofol 2.0-3.0 mg·kg-1 or sevoflurane up to 8.0 Vol% provide acceptable, i.e. excellent or good intubating conditions. We hypothesized that sevoflurane 1.0 MAC would provide acceptable intubating conditions when combined with propofol and remifentanil.MethodsEighty-three patients to be intubated were randomised to two groups. The SEVO group received propofol 1.5 mg kg-1, remifentanil 0.30 μg kg min-1 and sevoflurane 1.0 MAC; the MR group received the same doses of propofol and remifentanil plus rocuronium 0.45 mg kg-1. We evaluated intubation and extubation conditions, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS). The vocal cords were examined for injury by videolaryngoscopy before and 24 hours after surgery.ResultsAcceptable intubating conditions were seen more frequently with rocuronium than with sevoflurane: 97% versus 82%; p = 0.03; the subscore for vocal cords was comparable: 100% versus 98%. MAP before intubation decreased significantly compared with the MAP at baseline to the same extent in both groups; ephedrine IV was given in 15 (SEVO) versus 16 (MR) patients; p = 0.93. BIS at tracheal intubation was 27 (13-65) in the SEVO group, 29 (14-62) in the MR group; p = 0.07. Vocal cord injuries (oedema, haematoma) were similar: 4 patients in each group.ConclusionsOverall intubating conditions were better when rocuronium was used; the subscore for vocal cords was comparable. The incidence of side effects was the same in the two groups.Trial registrationClinicalTrials.Gov: NCT 01591031.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial

et al. 2014

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“…These registries allow insights into not only individual and group performance but also infrequent outcomes such as failed intubations and rescue intubations. Although rescue intubation is deemed to be important [ 3 , 30 - 32 ], previous studies in the ED setting only examined the characteristics of rescue intubations and the predictors for successful rescue attempts after one failed attempt (i.e., not after multiple failed intubation attempts) [ 8 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Multiple failed intubation attempts are associated with decreased success rates on the first rescue intubation in the emergency department: a retrospective analysis of multicentre observational data

Goto

Gibo

Hagiwara

et al. 2015

Scand J Trauma Resusc Emerg Med

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BackgroundAlthough the international guidelines emphasize early and systematic use of rescue intubation techniques, there is little evidence to support this notion. We aimed to test the hypothesis that preceding multiple failed intubation attempts are associated with a decreased success rate on the first rescue intubation in emergency departments (EDs).MethodsWe analysed data from two multicentre prospective registries designed to characterize current ED airway management in Japan between April 2010 and June 2013. All patients who underwent a rescue intubation after a failed attempt or a series of failed attempts were included for the analysis. Multiple failed intubation attempts were defined as ≥2 consecutive failed intubation attempts before a rescue intubation. Primary outcome measure was success rate on the first rescue intubation attempt.ResultsOf 6,273 consecutive patients, 1,151 underwent a rescue intubation. The success rate on the first rescue intubation attempt declined as the number of preceding failed intubation attempts increased (81% [95% CI, 79%-84%] after one failed attempt; 71% [95% CI, 66%-76%] after two failed attempts; 67% [95% CI, 55%-78%] after three or more failed attempts; Ptrend <0.001). In the multivariable analysis adjusting for age, sex, principal indication, change in methods, devices, and intubator specialty, and clustering of patients within EDs, success rate on the first rescue intubation after two failed attempts was significantly lower (OR, 0.56; 95% CI, 0.41-0.77) compared to that after one failed attempt. Similarly, success rate on the first rescue intubation attempt after three or more failed attempts was significantly lower (OR, 0.49; 95% CI, 0.25-0.94) compared to that after one failed attempt.ConclusionPreceding multiple failed intubation attempts was independently associated with a decreased success rate on the first rescue intubation in the ED.

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“…For these reasons, it may be preferred over succinylcholine in compromised patients in whom hemodynamic or other changes are to be minimized. A dose of rocuronium usually used for Rapid Sequence Induction (RSI) 1mg/kg, allows rapid paralysis (60 to 90 seconds) but the duration of action is prolonged (35-75 minutes), making it unsuitable in difficult airway scenarios in the unavailability of sugammadex 6 . One study by Sørensen M et al 7 has shown that with rocuronium, 93% of cases had excellent intubation, while with succinylcholine, 76% of cases had excellent intubation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Rocuronium and Succinylcholine for Rapid Sequence Induction in patients undergoing surgery under General Anaesthesia

Wahid¹,

Hussain²,

Rahman³

et al. 2020

JRMC

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Objectives: To compare the frequency of excellent intubation condition with Succinylcholine and rocuronium for rapid sequence induction in patients undergoing surgery under general anesthesia. Design: Randomized control trial. Place and duration of study: Department of anesthesiology and pain medicine, Combined Military Hospital Malir Cantt Karachi from 25th June to 10th August 2019. Methodology: In this randomized control trial, a non-probability consecutive sampling technique was used. Anesthesia was given through a standard approach. Then patients were randomly divided into two equal groups. In group A, succinylcholine (1mg/Kg) was given while in group B, rocuronium (1mg/Kg) was given. Laryngoscopy was attempted after 60 seconds. Intubating conditions were labeled as excellent, good, poor, and impossible. All the data was collected in two groups, the data was entered and analyzed on SPSS version 21. Results: The mean age of the patients was 40.11±9.49 years. The male to female ratio of the patients was 0.7:1. The study results showed the excellent intubation conditions were noted in 11 from group A and 9 from group B, good intubation condition was noted in 29 from group A and 25 from group B, poor conditions were noted in 17 from group A and 16 from group B and the impossible intubation conditions were noted in 13 from group A and 20 from group B. Statistically insignificant difference was found between the study groups with intubation conditions i.e. p-value=0.570. Conclusion: It has been proved in our study that both the succinylcholine and rocuronium are statically equally effective in terms of excellent intubation conditions in the management of rapid sequence induction in patients undergoing surgery under general anesthesia.

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Hemoglobin Desaturation After Propofol/Remifentanil-Induced Apnea

Cited by 16 publications

References 19 publications

Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial

Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial

Multiple failed intubation attempts are associated with decreased success rates on the first rescue intubation in the emergency department: a retrospective analysis of multicentre observational data

Comparison of Rocuronium and Succinylcholine for Rapid Sequence Induction in patients undergoing surgery under General Anaesthesia

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