[Rapid sequence intubation in emergency: is there any place for fentanyl?].
OBJECTIVE
Rapid sequence intubation (RSI) with the association of etomidate and succinylcholine is the French "Gold standard" for urgent "full stomach" endotracheal intubations. The aim of this study is to assess the fentanyl as a co-induction agent to take over the sedation between the RSI and the keeping of sedation, which is a critical period in which harmful neuro-vegetatives events, and awakening signs are frequently seen.


METHODS
Randomized, double blind controlled prospective study, after acceptation by the local ethical committee.


METHODS
Three groups of patients undergoing RSI in the intensive care unit and by the out-of-hospital medical team were compared: group A patients received fentanyl 3 micrograms kg-1 during RSI, before paralysis was induced. Group B patients received the same dose of fentanyl immediately after endotracheal intubation. Group C patients did not received fentanyl (control group). Outcome measures were awakening signs arrival (respiratory movements, eyes opening, spontaneous limb movements), Ramsay score assessment, and haemody namics. Attempt at intubation and vomiting incident were also measured. Discrete data were compared by chi-2 analysis, continuous data were compared with two-way analysis of variance. A p value < 0.05 was the significant threshold.


RESULTS
Thirty-six patients were enrolled and completed the study. All the included patients presented awakening signs. The use of fentanyl did not prevent the recourse of other sedative medications. Ten minutes after endotracheal intubation, significant differences has been noticed for the awakening signs arrival between fentanyl groups (A: 42% and B: 36%) and control group (C: 77%). The Ramsay score evolution follows the same variation. All the patients were intubated on the first attempt, there was no vomiting incident noticed.


CONCLUSIONS
The use of fentanyl, as a co-induction agent with etomidate and succinylcholine during RSI, allows a significant delay of the awakening signs arrival and attenuate the neurovegetative response during the minutes after endotracheal intubation after RSI, without deleterious haemodynamic effects.
Gindre
S
S
Département d'anesthésie et de réanimation, CHU de Nice, hôpital Saint-Roch, 5, rue Pierre-Devoluy, BP 1319, 06006 Nice, France. stephanegindre@yahoo.fr
Ciais
J F
JF
Levraut
J
J
Dellamonica
J
J
Guerin
J P
JP
Grimaud
D
D
D000771:Anesthesia, Intravenous / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D016292:Procedural Sedation; D003422:Critical Care; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004632:Emergency Medical Services / Q000379:methods*; D005045:Etomidate; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009467:Neuromuscular Depolarizing Agents; D011446:Prospective Studies; D013270:Stomach / Q000502:physiology; D013390:Succinylcholine
D018686:Anesthetics, Intravenous; D009467:Neuromuscular Depolarizing Agents; D013390:Succinylcholine; D005283:Fentanyl; D005045:Etomidate