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

Abstract

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.

Approach to the Airway in the Emergency Department (ED) and Intensive Care Unit (ICU) in a Portuguese University Hospital Center: a prospective observational study

“…Regardless of the recommendation of using neuromuscular blocking agents, as it reduces intubation complications in the critically ill [5], as well as it improves overall intubating conditions [12], in our study they were used only in 25% of cases, however, no relation was found between drugs used in the airway approach and complications rate. It is crucial for critical care physicians to have skills in advanced airway management as the adoption of algorithmic approaches and rapid-sequence intubation by anesthesiologists and emergency medicine physicians improved the successful rates for the emergency intubations in the critically ill and reduced complications [13].…”

Sevoflurane at 1.0 MAC together with remifentanil and propofol produces clinically acceptable intubation conditions at the vocal cords: A prospective randomized study

“… 5 Extubation conditions were also assessed ( Table 1 ). 4 Additionally, the following intubation variables were assessed: Cormack–Lehane grade, number of intubation attempts, and time required for tracheal intubation (time in seconds from the initial insertion of the laryngoscope into the patient’s mouth until blocking of the cuff).…”

“…Neuromuscular blocking agents (NMBAs) are not used in up to 25% of tracheal intubations in Germany and Denmark. 1 – 3 In 2014, we found that tracheal intubation with propofol, remifentanil, and sevoflurane (Sevo) at 1.0 minimum alveolar concentration (MAC) and tracheal intubation with propofol, remifentanil, and rocuronium at 0.45 mg/kg produced comparable intubation conditions at the vocal cords; 4 moreover, these two techniques had comparable side effects including arterial hypotension and vocal cord injuries. The overall intubation conditions, however, were better with rocuronium than Sevo.…”

Çocuklarda kas gevşeticisiz trakeal entübasyon

“…Daha önce remifentanil, propofol ve sevofluran 1 MAK ile yeterli entübasyon koşulunun sağlandığı diğer çalışmalarda ortaya konulmuştur (9). Ancak benzer çalışmalarda opioid rijiditesini önlemek için premedikasyonda uygulanan midazolam, hipnotik ajan olarak uygulanmamıştır.…”