[Endotracheal intubation under propofol with or without vecuronium]

Abstract

Objective: In order to test the hypothesis that under the association propofol-alfentanil-IV lidocaine the trachea could be intubated easily without an additional muscle relaxant, this study compared the intubation conditions when this association was combined or not with vecuronium.

Study design: Randomized comparative trial.

Patients: The study included 152 young adults classified as ASA physical class I and Mallampati presentation grade 1, randomly allocated either into Vecu+ group or Vécu0 group, depending on whether vecuronium was co-administered or not.

Methods: All patients received midazolam 0.05 mg.kg-1 i.v., one minute before induction. Those of group Vecu0 were given successively within two minutes: alfentanil 0.03 mg.kg-1, lidocaine 1.5 mg.kg-1 i.v. and propofol 2.5 mg.kg-1. Patients of group Vecu+ received similar doses of alfentanil and propofol as well as vecuronium 0.08 mg.kg-1. The endotracheal tube was inserted one minute after induction in the patients of Vecu0 group, and after three minutes in those of the Vecu+ group. During intubation, scores of mouth opening, glottis opening and coughing were established, in order to assess intubation conditions.

Results: Similar convenient intubating conditions were obtained in both groups (in 97% of patients in Vecu+ group vs 95% of those in Vecu0 group). In the latter, the glottis opening was less pronounced.

Conclusions: In young healthy adults, without anaesthetic risk (emergency, full stomach) and without foreseen difficult intubation, the endotracheal tube can be inserted in convenient conditions without a muscle relaxant, under the association propofol-alfentanil-lidocaine iv.