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Canadian Journal of Anesthesia 48:646-650 (2001)
© Canadian Anesthesiologists' Society, 2001
General Anesthesia

Sevoflurane with remifentanil allows rapid tracheal intubation without neuromuscular blocking agents

[Le sévoflurane, additionné de rémifentanil, permet une intubation endotrachéale rapide sans myorelaxant]

Hwan S. Joo , MD FRCPC*, William J. Perks , BSc PHM{dagger} and Susan E. Belo , MD PhD FRCPC*

* From theDepartment of Anaesthesia and the ,
{dagger} Department of Pharmacy St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Hwan Joo, Department of Anaesthesia, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. Phone: 416-864-5071; Fax: 416-864-6014; E-mail: hwanjoomd{at}yahoo.com Reprints will not be available from the author.

Purpose: After inhalational induction with sevoflurane, we compared the effects of adding remifentanil 1 µg•kg–1 or remifentanil 2 µg•kg–1 on conditions for tracheal intubation without neuromuscular blocking agents.

Methods: Before anesthetic induction, all patients were given 0.2 mg of glycopyrrolate iv to counteract the bradycardic effects of remifentanil. Two minutes after inhalational induction with 8% sevoflurane and 50% nitrous oxide, 56 female patients with normal airways scheduled for gynecologic surgery were randomized to receive remifentanil 1 or 2 µg•kg–1 in a double-blind fashion. One minute later, laryngoscopy was initiated for tracheal intubation. Conditions for tracheal intubation and hemodynamic response to tracheal intubation were assessed.

Results: Tracheal intubation was successful in all patients. The incidence of post-intubation coughing was lower in the remifentanil 2 µg•kg–1 group compared to remifentanil 1 µg•kg–1 group (11% vs 39%, P <0.02). Optimal intubation conditions were also higher in the remifentanil 2 µg•kg–1 group at 89% vs 54% (P <0.01). However, the higher dose of remifentanil also resulted in a greater decrease in mean arterial pressure (P <0.05).

Conclusions: The addition of remifentanil after sevoflurane induction allows for rapid tracheal intubation without neuromuscular blocking agents. The higher dose of remifentanil results in improved conditions for tracheal intubation but also caused a greater decrease in mean arterial pressure. Tracheal intubation using sevoflurane and remifentanil may be an alternative to traditional tracheal intubation with neuromuscular blocking agents.




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H. Yang, P. T.-L. Choi, J. McChesney, and N. Buckley
Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery: [L'induction avec sevoflurane-remifentanil ou propofol-fentanyl rocuronium est similaire quant aux NVPO en chirurgie laparoscopique]
Can J Anesth, August 1, 2004; 51(7): 660 - 667.
[Abstract] [Full Text] [PDF]


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