The clinical effective dose of rocuronium for lightwand tracheal intubation after induction with alfentanil, propofol, and low concentrations of sevoflurane

Abstract

BackgroundThe aim of this study was to determine the clinical effective dose of rocuronium for tracheal intubation using a lightwand after induction with propofol, alfentanil, and a low concentration of sevoflurane.MethodsTwenty-eight adults scheduled to undergo elective surgery lasting less than one hour were enrolled in this study. All patients received alfentanil (10 µg/kg) and propofol (1.5 mg/kg) for the induction of anesthesia. Tracheal intubation using a lightwand was attempted 3 minutes after administering rocuronium and mask ventilation with 2 vol% of sevoflurane. The initial rocuronium dose was 0.5 mg/kg. The rocuronium dose for consecutive patients, determined by Dixon's up-and-down method, was increased or decreased by 0.05 mg/kg according to the result of the previous patient. The mean arterial pressure and heart rate were recorded before induction, 1 min before intubation, 1 and 2 min after intubation.ResultsThe 50% clinical effective dose (cED50) of rocuronium for tracheal intubation using a lightwand was 0.20 ± 0.05 mg/kg according to Dixon's up and down method. Isotonic regression revealed the cED50 and cED95 (95% confidence intervals) to be 0.20 mg/kg (0.10-0.3 mg/kg) and 0.35 mg/kg (0.16-0.49 mg/kg), respectively.ConclusionsThe cED50 and cED95 of rocuronium for tracheal intubation using the lightwand were 0.20 mg/kg and 0.35 mg/kg, respectively, after induction with alfentanil, propofol, and a low concentration of sevoflurane.

Evaluation of Factors Affecting Illumination Intensity in Lightwand Endotracheal Intubation

“…Park et al described the optimal doses of rocuronium in lightwand intubation for short surgical procedures or outpatient surgery. The 50% and 95% clinical effective doses of rocuronium were 0.2 mg/kg and 0.35 mg/kg, respectively, which were lower than those for direct laryngoscopy intubation because rapid return to spontaneous ventilation is needed for day-care surgery (19). Few studies have reported clinical factors affecting successful lightwand intubation (4).…”

Intubation for short procedures

“…It has been shown to have a lowest optimal dose of 0.2 mg/kg, which provides good intubating conditions within three minutes, and a return of the first twitch on a train-of-four (TOF) at 15 minutes with a full TOF by 30 minutes. 4,5,6 Topicalising the airway The use of lignocaine, sprayed onto the vocal cords, aids intubation, but may not prevent the coughing experienced once the tube enters the trachea. Patients are often uncomfortable, with a resultant hoarse voice that may persist for a few hours.…”