Tracheal intubation without muscle relaxants: remifentanil or alfentanil in combination with propofol

Incidence of postoperative shivering comparing remifentanil with other opioids: a meta-analysis

“…When we separated the study protocols to enable a comparison of remifentanil use with the administration of alfentanil, fentanyl, or sufentanil, we found that remifentanil was associated with an increased incidence of postoperative shivering compared with alfentanil (RR = 2.73; 95% CI, 1.72-4.34; P b .0001; I 2 = 0.00%; Cochran's Q = 5.27) [1,2,11,[16][17][18][19][20][21][22][23][24][25][26][27][28]31,32] or fentanyl (RR = 2.04; 95% CI, 1.60-2.60; P b .00001; I 2 = 0.00%; Cochran's Q = 1.13) [3,10,12,19,30,33,34], but no significant difference was seen when compared with sufentanil (RR = 2.13; 95% CI, 0.67-6.74; P = .20; I 2 = 0.00%; Cochran's Q = 1.07) [17,18,29] as shown in Figure 2. The study protocol included the use of propofol or inhalation anesthesia for the maintenance of anesthesia.…”

“…However, the incidence of postoperative shivering related to sufentanil administration could not be determined because of the limited number of articles. The meta-analysis by Komatsu et al included results contained in conference abstracts [14,15], and we were unable to acquire the results of 1 postoperative shivering trial [16]. In addition, papers that have been published since the meta-analysis by Komatsu et al showed no significant difference in the incidence of shivering when remifentanil was compared with fentanyl or sufentanil [17][18][19].…”

The optimal dose of remifentanil for acceptable intubating conditions during propofol induction without neuromuscular blockade

“…Stevens and Wheatley et al [6] reported that remifentanil at doses of 3.0 and 4.0 μg/kg in combination with propofol decreased postintubation HR and MAP compared with preinduction values. The decrease in MAP and HR was well tolerated in healthy patients and did not require additional treatment [13,25].…”

The optimal effect-site concentration of remifentanil for lightwand tracheal intubation during propofol induction without muscle relaxation

“…In healthy outpatients, bolus administration of remifentanil provided effective control of the acute hemodynamic response to tracheal intubation with [7] and without muscle relaxants [5,6]. In children, Min et al [15] showed that the optimal bolus dose of remifentanil for successful tracheal intubation was 0.56 μg/kg in 50% of children during inhalation induction using 5% sevoflurane in oxygen without neuromuscular blocking agents.…”

“…Patients who are not first given a muscle relaxant undergo more intubation attempts, require greater intubation time, and experience a higher incidence of events during intubation than those who receive a muscle relaxant [4]. Tracheal intubation may be accomplished without muscle relaxants, but satisfactory conditions are not reliably obtained in all patients [5,6].…”