Tracheal intubating conditions after induction with propofol, remifentanil and lignocaine

Le sévoflurane, additionné de rêmifentanil, permet une intubation endotrachéale rapide sans myorelaxant

“…These results compare favourably to reported results of propofol/remifentanil tracheal intubation without neuromuscular blocking agents at 35-100%. [4][5][6][7] Potential problems with the use of remifentanil during anesthetic induction include hypoventilation, muscle rigidity and bradycardia. 3 Muzi et al studied methods to decrease the time to adequate depth of anesthesia with sevoflurane for tracheal intubation and found that when fentanyl was given before sevoflurane induction, it actually increased time to successful tracheal intubation due to hypoventilation and muscle rigidity.…”

Optimal remifentanil dosage for providing excellent intubating conditions when co‐administered with a single standard dose of propofol

“…Excellent intubating conditions are important to minimise the occurrence of damage to the airway, the fourth highest cause of claims related to injuries associated with general anaesthesia [1,2]. The use of neuromuscular blocking drugs at induction of anaesthesia provides significantly better intubating conditions and less vocal cord sequelae than relaxant-free anaesthesia, and has therefore been advocated prior to tracheal intubation for elective surgery [2,3].However, patient factors may contraindicate the use of neuromuscular blocking drugs, and administration of these drugs is associated with several complications, including anaphylactic reactions, residual curarisation, and awareness during general anaesthesia [4][5][6].Significant improvements in the quality of tracheal intubation without paralysis were reported when remifentanil was co-administered with propofol 2 or 2.5 mg.kg )1 [7][8][9][10][11][12][13]. However, the optimal dose of remifentanil required for providing excellent intubating conditions when co-administered with propofol remains unknown since published results are inconsistent [7][8][9][10][11][12][13][14].…”

How low can you go? Lowest effective dose of neuromuscular blocking agent for tracheal intubation

“…Woods et al achieved considerable success with remifentanil doses as low as 1 lg Á kg -1 when the drug was combined with lidocaine 1.5 mg Á kg -1 . 13 Thus, it remains unclear to what degree adding rocuronium contributed to the excellent intubation scores reported by the present authors.…”

“…ont rencontré un succès remarquable avec des doses de rémifentanil aussi basses que 1 lgÁkg -1 lorsque l'agent était combiné à de la lidocaïne 1,5 mgÁkg -1 . 13 Dès lors, nous ne pouvons déter-miner clairement dans quelle mesure le fait d'ajouter du rocuronium a réellement contribué aux scores d'intubation excellents rapportés par les auteurs de l'étude présentée ici.…”