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Randomized Controlled Trial
. 2014 May 22:14:39.
doi: 10.1186/1471-2253-14-39. eCollection 2014.

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

Thomas Mencke  1 , Refa Maria Jacobs  1 , Susann Machmueller  1 , Martin Sauer  1 , Christine Heidecke  2 , Anja Kallert  2 , Hans Wilhelm Pau  2 , Gabriele Noeldge-Schomburg  1 , Attila Ovari  2
Affiliations
Randomized Controlled Trial

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

Thomas Mencke et al. BMC Anesthesiol. .

Abstract

Background: Tracheal 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.

Methods: Eighty-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.

Results: ACCEPTABLE 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.

Conclusions: Overall 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 registration: ClinicalTrials.Gov: NCT 01591031.

Trial registration: ClinicalTrials.gov NCT01591031.

Keywords: Intubating conditions; Laryngeal injury; Neuromuscular block; Propofol; Remifentanil; Sevoflurane.

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Figures

Figure 1
Figure 1
Flow chart of patient distribution.
Figure 2
Figure 2
Patients (%) with excellent (black bars), good (grey bars) and poor intubation conditions (white bars). *p = 0.06 MR group versus SEVO group overall; p = 0.029 clinically acceptable (excellent and good) conditions. SEVO group = Induction of anaesthesia with sevoflurane. MR group = Induction of anaesthesia with rocuronium.
Figure 3
Figure 3
Patients (%) with excellent (black bars), good (grey bars) and poor intubation conditions (white bars) for subscore laryngoscopy. *p = 0.06 MR group versus SEVO group. SEVO group = Induction of anaesthesia with sevoflurane. MR group = Induction of anaesthesia with rocuronium.
Figure 4
Figure 4
Patients (%) with excellent (black bars), good (grey bars) and poor intubation conditions (white bars) for subscore vocal cords. MR group versus SEVO group: p = 0.59. SEVO group = Induction of anaesthesia with sevoflurane. MR group = Induction of anaesthesia with rocuronium.
Figure 5
Figure 5
Patients (%) with excellent (black bars), good (grey bars) and poor intubation conditions (white bars) for subscore reaction to tube insertion or cuff inflation. *p = 0.02 MR group versus SEVO group. SEVO group = Induction of anaesthesia with sevoflurane. MR group = Induction of anaesthesia with rocuronium.
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References

    1. Bouvet L, Stoian A, Rimmelé T, Allaouchiche B, Chassard D, Boselli E. Optimal remifentanil dosage for providing excellent intubating conditions when co-administered with a single standard dose of propofol. Anaesthesia. 2009;64:719–726. doi: 10.1111/j.1365-2044.2009.05916.x. - DOI - PubMed
    1. Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants. Anesth Analg. 1998;86:45–49. - PubMed
    1. Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, Fuchs-Buder T. Laryngeal morbidity and quality of tracheal intubation. A randomized controlled trial. Anesthesiology. 2003;98:1049–1056. doi: 10.1097/00000542-200305000-00005. - DOI - PubMed
    1. Erhan E, Ugur G, Alper I, Gunusen I, Ozyar B. Tracheal intubation without muscle relaxants: remifentanil or alfentanil in combination with propofol. Eur J Anaesthesiol. 2003;20:37–43. doi: 10.1097/00003643-200301000-00007. - DOI - PubMed
    1. Baillard C, Adnet F, Borron SW, Racine SX, Ait Kaci F, Fournier JL, Larmignat P, Cupa M, Samama CM. Tracheal intubation in routine practice with and without muscular relaxation: an observational study. Eur J Anaesthesiol. 2005;22:672–677. doi: 10.1017/S0265021505001110. - DOI - PubMed

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