title: Sevoflurane with remifentanil allows rapid tracheal intubation without neuromuscular blocking agents.
abstract: OBJECTIVE
  After inhalational induction with sevoflurane, we compared the effects of adding remifentanil 1 microg x kg(-1) or remifentanil 2 microg x 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 microg x 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 microg x kg(-1) group compared to remifentanil 1 microg x kg(-1) group (11% vs 39%, P <0.02). Optimal intubation conditions were also higher in the remifentanil 2 microg x 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.
authors.affiliation: Department of Anaesthesia and the, Department of Pharmacy St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. hwanjoomd@yahoo.com
authors.forename: H S
authors.initials: HS
authors.lastname: Joo
authors.forename: W J
authors.initials: WJ
authors.lastname: Perks
authors.forename: S E
authors.initials: SE
authors.lastname: Belo
mesh_terms: D000759:Adjuvants, Anesthesia; D000293:Adolescent; D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation; D001794:Blood Pressure / Q000502:physiology; D004562:Electrocardiography; D005260:Female; D013509:Gynecologic Surgical Procedures; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008738:Methyl Ethers; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents; D010880:Piperidines; D000077208:Remifentanil; D000077149:Sevoflurane
chemical_list: D000759:Adjuvants, Anesthesia; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D009466:Neuromuscular Blocking Agents; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil