Tracheal intubation in intellectually disabled patients: Clinical usefulness of remifentanil and sevoflurane without a muscle relaxant

Çağiran, Esra; Eyigör, Can; Balcioglu, Taner; Uyar, Meltem

doi:10.1177/0300060513497561

Cited by 7 publications

(10 citation statements)

References 24 publications

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“…Mean arterial pressure and heart rate were significantly lower immediately before tracheal intubation with sevoflurane. Adding remifentanil 2.0 μg·kg -1 to sevoflurane 8 Vol% resulted in acceptable intubating conditions in 29 of 30 patients [7], a similar incidence to intubating conditions with rocuronium 0.6 mg·kg -1 [23]. Cros et al applied a modified Dixon’s up-and-down method to remifentanil 1.0 μg·kg -1 followed by an infusion of 0.25 μg·kg -1 ·min -1 , increasing or decreasing sevoflurane in 0.5% steps.…”

Section: Discussionmentioning

confidence: 99%

“…Alternative hypnotic agents are etomidate, thiopental and sevoflurane [6,7]. Because poor intubating conditions are associated with vocal cord injury [3] it is important to achieve good or excellent, i.e., acceptable, intubating conditions.…”

Section: Introductionmentioning

confidence: 99%

“…Because poor intubating conditions are associated with vocal cord injury [3] it is important to achieve good or excellent, i.e., acceptable, intubating conditions. Remifentanil, 1.0 to 4.0 μg·kg -1 combined with propofol, provides acceptable intubating conditions [1,2,4], but these doses may cause arterial hypotension and severe bradycardia [7,8]. The remifentanil infusion rate can be reduced when a volatile anaesthetic such as isoflurane is added rather than propofol [9].…”

Section: Introductionmentioning

confidence: 99%

“…The remifentanil infusion rate can be reduced when a volatile anaesthetic such as isoflurane is added rather than propofol [9]. Sevoflurane 8 Vol% (i.e., 4.0 minimal alveolar concentration; MAC) combined with remifentanil 2.0 μg·kg -1 provided acceptable intubating conditions in 97% of patients, but mean arterial pressure (MAP) decreased by about 25% [7]. We hypothesized that sevoflurane 1.0 MAC would provide clinically acceptable intubating conditions, when combined with a standard anaesthesia induction with propofol and a continuous infusion of remifentanil.…”

Section: Introductionmentioning

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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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: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…Alternatif opioid ajanlar alfentanil, fentanil ve sulfentanil, hipnotik ajanlarsa etomidat, tiopental ve sevofuran olarak sıralanmaktadır (7,8).…”

Section: Introductionunclassified

Çocuklarda kas gevşeticisiz trakeal entübasyon

Akaslan¹,

Özcan²,

Karakoç³

2016

Ege Tıp Dergisi

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Aim: Tracheal intubation without muscle relaxants is usually performed with alfentanil and propofol or sevoflurane. Alfentanil 5 to 40 μg/kg, propofol 2.0-4.0 mg/kg sevoflurane up to 1 MAC provide excellent or good intubation conditions. Effect of midazolam as a hypnotic agent which is combined with alfentanil and 1 MAC sevoflurane, on hemodynamic parameters and intubation conditions is evaluated. Materials and Methods

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

et al. 2017

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ObjectiveThe overall intubation conditions after tracheal intubation with remifentanil, propofol, and sevoflurane at 1.0 minimum alveolar concentration (MAC) are worse than with rocuronium at 0.45 mg/kg. Therefore, we compared the intubation conditions and laryngeal morbidity (vocal cord injuries, hoarseness, and sore throat) with sevoflurane at 1.2 and 1.4 MAC versus 1.0 MAC.MethodsIn this prospective clinical trial, 90 patients were randomized to 3 groups: the sevoflurane 1.0, 1.2, and 1.4 MAC groups. At 3 min, tracheal intubation was performed and the patients’ intubation conditions were assessed. The vocal cords were examined for injury by videolaryngoscopy. Additionally, the incidence and severity of laryngeal morbidity were compared between women and men.ResultsAcceptable intubation conditions were seen in 72% of the patients without significant differences between the groups. Overall, vocal cord injuries (oedema) occurred in three (4%) patients. Women reported sore throat more often than men (51% vs. 21%, respectively).ConclusionsIntubation conditions were not improved with higher sevoflurane concentrations. The incidence and severity of sore throat were greater in women than men.Trial registration: ClinicalTrials.Gov: NCT 01896245

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Tracheal intubation in intellectually disabled patients: Clinical usefulness of remifentanil and sevoflurane without a muscle relaxant

Cited by 7 publications

References 24 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

Çocuklarda kas gevşeticisiz trakeal entübasyon

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

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