title: Effect of remifentanil on the haemodynamic response to orotracheal intubation.
abstract: We have examined the effect of remifentanil on the haemodynamic response to orotracheal intubation in a randomized, double-blind study. We studied 40 patients allocated to one of four groups of 10 each, to receive the following immediately before induction of anaesthesia: remifentanil 1 microgram kg-1 bolus over 30 s, followed by an infusion of 0.5 microgram kg-1 min-1; saline placebo only; glycopyrrolate 200 micrograms and remifentanil 1 microgram kg-1 bolus over 30 s, followed by an infusion of 0.5 microgram kg-1 min-1; or glycopyrrolate 200 micrograms only. Anaesthesia was induced with propofol, vecuronium and 1% isoflurane with 66% nitrous oxide in oxygen. The trachea was intubated under direct laryngoscopy 3 min after induction of anaesthesia. Arterial pressure and heart rate were measured non-invasively, immediately before induction of anaesthesia and then at 1-min intervals. Remifentanil was found to effectively attenuate the pressor response to intubation (P < 0.05 for the increase in mean arterial pressure; P < 0.01 for the increase in heart rate). In the absence of a concurrent vagolytic agent, remifentanil was associated with bradycardia or hypotension, or both, in five of 10 patients, compared with one patient who received remifentanil and glycopyrrolate.
authors.affiliation: University Department of Anaesthesia, Leicester Royal Infirmary.
authors.forename: J P
authors.initials: JP
authors.lastname: Thompson
authors.forename: A P
authors.initials: AP
authors.lastname: Hall
authors.forename: J
authors.initials: J
authors.lastname: Russell
authors.forename: B
authors.initials: B
authors.lastname: Cagney
authors.forename: D J
authors.initials: DJ
authors.lastname: Rowbotham
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004347:Drug Interactions; D005260:Female; D006024:Glycopyrrolate / Q000494:pharmacology; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007442:Intubation, Intratracheal; D008875:Middle Aged; D010276:Parasympatholytics / Q000494:pharmacology; D010880:Piperidines / Q000494:pharmacology*; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D010276:Parasympatholytics; D010880:Piperidines; D000077208:Remifentanil; D006024:Glycopyrrolate