title: Tracheal intubation conditions and cardiovascular effects after modified rapid-sequence induction with sevoflurane-rapacuronium versus propofol-rapacuronium.
abstract: OBJECTIVE
  To compare intubation conditions and hemodynamic effects resulting from rapid-sequence induction of anesthesia with sevoflurane-rapacuronium and propofol-rapacuronium.
  
  
  METHODS
  Randomized, blinded study.
  
  
  METHODS
  Operating suites of a large university-affiliated medical center.
  
  
  METHODS
  40 ASA physical status I and II adult patients without airway abnormalities who were scheduled for elective surgery requiring endotracheal intubation.
  
  
  METHODS
  Patients were randomly allocated to receive either sevoflurane inhalational induction (Group 1) or propofol (2 mg/kg) intravenous induction (Group 2). Group 1 patients were coached on how to perform vital capacity breathing and the anesthesia machine was primed with sevoflurane 8%, N2O:O2 3.5:1.5 L/min. In both groups, when loss of consciousness was established, rapacuronium 1.5 mg/kg was administered. After 50 seconds, an anesthesiologist blinded to the study entered the room and attempted laryngoscopy and intubation.
  
  
  METHODS
  Intubation conditions were graded as excellent, good, poor, or impossible according to Good Clinical Research Practice (GCRP) criteria. Arterial blood pressure and heart rate changes accompanying both induction techniques were also monitored and recorded.
  
  
  RESULTS
  All patients were successfully intubated within 60 seconds. Clinically acceptable intubating conditions (excellent or good scores) were obtained in 19 of 20 Group 1 patients and in 19 of 20 Group 2 patients. Moderate tachycardia was encountered in both groups and mild systolic hypotension in the Group 2 patients. There were no complications.
  
  
  CONCLUSIONS
  Modified rapid-sequence inhalational induction using sevoflurane and rapacuronium produced clinically acceptable intubation conditions within 60 seconds of muscle relaxant administration. The intubation conditions were similar to those produced after intravenous propofol and rapacuronium.
authors.affiliation: Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.
authors.forename: Mohammad I
authors.initials: MI
authors.lastname: El-Orbany
authors.forename: Yaser
authors.initials: Y
authors.lastname: Wafai
authors.forename: Ninos J
authors.initials: NJ
authors.lastname: Joseph
authors.forename: M Ramez
authors.initials: MR
authors.lastname: Salem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents; D015742:Propofol; D000077149:Sevoflurane; D016037:Single-Blind Method; D014673:Vecuronium Bromide / Q000031:analogs & derivatives*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D000077149:Sevoflurane; D014673:Vecuronium Bromide; C082938:rapacuronium; D015742:Propofol