The online version of this article (doi:10.1186/1471-2253-14-39) contains supplementary material, which is available to authorized users.
There was no financial support or sponsorship. None of the authors has any conflict of interest.
TM made substantial contributions to conception and design, acquisition of data, and statistical analysis and interpretation of data; he drafted the article and he approved the final version to be published. RMJ made substantial contributions to conception and design; she performed the tracheal intubations; she revised the article critically for important intellectual content; and she approved the final version of the manuscript. SM made substantial contributions to the conception and to the design and acquisition of data; she revised the manuscript before submission and approved the final version. CH made substantial contributions to design and acquisition of data; she performed the videolaryngoscopy, revised the article critically for important intellectual content, and approved the final version of the manuscript. AK made substantial contributions to acquisition of data and interpretation of data; she performed the videolaryngoscopy and revised the article before submitting. MS made substantial contributions to conception and design, acquisition of data, and interpretation of data, revised the article critically for important intellectual content, and approved the final version. HWP made substantial contributions to conception and design and analysis of data; he revised the article and approved the final version. GNS made substantial contributions to conception and design and interpretation of data, revised the manuscript and approved the final version. AV made substantial contributions to conception and design, collected and analysed data, performed the videolaryngoscopy, revised the manuscript for important intellectual content, and approved the final version of the manuscript before submitting it. All authors read and approved the final manuscript.
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.
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.
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.
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.
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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
Refa Maria Jacobs
Hans Wilhelm Pau
- BioMed Central
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