[Intratracheal intubation without muscle relaxant with the use of remifentanil-propofol].
OBJECTIVE
To assess tracheal intubation conditions after induction of anaesthesia with remifentanil and propofol, using itemized scoring criteria.


METHODS
Clinical, prospective, open, non comparative trial.


METHODS
One hundred consecutive patients undergoing surgery not requiring muscle relaxation, during the study period extended over 12 months.


METHODS
After premedication with lorazepam (2 mg) the day before and hydroxyzine (100 mg) one hour before surgery, anaesthesia was induced with remifentanil administered continuously with a syringe pump at a rate of 1.20 +/- 0.06 micrograms.kg-1.min-1 and propofol (3 mg.kg-1 IV bolus). The trachea was intubated two minutes later and mouth opening, glottis exposure, glottis opening, movements, additional anaesthetic agents and chest rigidity were recorded.


RESULTS
Intubation conditions were excellent in 87% of patients, and the tube was inserted rapidly, within two minutes. However in 38% of patients the cuff inflation caused cough. In 13%, glottis opening was delayed and intubation required three minutes. A major decrease of arterial pressure and heart rate was recorded in 9 and 6% of patients respectively.


CONCLUSIONS
Induction of anaesthesia using remifentanil and propofol allows satisfactory tracheal intubation without a muscle relaxant. However this technique is contraindicated: a) in patients with a full stomach, as intubation is not always successful at the first attempt; b) in patients scheduled to undergo neurosurgery or ophthalmic surgery, as tracheal intubation may elicit cough, increasing intra-cranial and intra-ocular pressure; c) in patients in poor circulatory status, as it decreases significantly arterial pressure and heart rate.
Boulesteix
G
G
Département d'anesthésie, CHA A-Calmette, Lorient Naval, France.
Simon
L
L
Lamit
X
X
Aubineau
J V
JV
Caire
P
P
Kindelberger
P
P
D000771:Anesthesia, Intravenous / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D000075202:Contraindications; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006919:Hydroxyzine; D007442:Intubation, Intratracheal / Q000379:methods*; D008140:Lorazepam; D009125:Muscle Relaxants, Central; D010880:Piperidines / Q000008:administration & dosage*; D011292:Premedication; D015742:Propofol / Q000008:administration & dosage*; D000077208:Remifentanil
D018686:Anesthetics, Intravenous; D009125:Muscle Relaxants, Central; D010880:Piperidines; D006919:Hydroxyzine; D008140:Lorazepam; D000077208:Remifentanil; D015742:Propofol
Intubation trachéale sans myorelaxant avec l'association rémifentanil-propofol.