Does the choice of intravenous induction drug affect intubation conditions after a fast-onset neuromuscular blocker?
OBJECTIVE
To compare intubation conditions and hemodynamic effects resulting from thiopental-rapacuronium, propofol-rapacuronium, and etomidate-rapacuronium intravenous (IV) induction.


METHODS
Randomized, blinded study.


METHODS
Operating suites of a large university-affiliated medical center.


METHODS
60 ASA physical status I and II adult patients without airway abnormalities, who were scheduled for elective surgery requiring endotracheal intubation. Patients were randomly allocated to receive IV thiopental sodium 5 mg/kg (Group 1), propofol 2 mg/kg (Group 2), or etomidate 0.3 mg/kg (Group 3) followed by rapacuronium 1.5 mg/kg. Fifty seconds later, an anesthesiologist, who had no knowledge of the induction drug used, entered the operating room and attempted laryngoscopy and intubation.


METHODS
Intubation conditions were graded as excellent, good, poor, or impossible according to Good Clinical Research Practice criteria. Arterial blood pressure and heart rate changes accompanying both induction techniques were also monitored and recorded.


RESULTS
All patients were intubated within 55 to 70 seconds. Clinically acceptable intubation conditions were not statistically different among the three groups. Moderate tachycardia after induction was seen in all three groups, and blood pressure was significantly lower in Group 2 than in Groups 1 or 3.


CONCLUSIONS
Clinically acceptable intubation conditions are similar after either thiopental, propofol, or etomidate when a fast-onset neuromuscular blocking drug (rapacuronium 1.5 mg/kg) is used to facilitate tracheal intubation.
El-Orbany
Mohammad I
MI
Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago 60657, USA.
Wafai
Yaser
Y
Joseph
Ninos J
NJ
Salem
M Ramez
MR
D000328:Adult; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000502:physiology; D004311:Double-Blind Method; D005045:Etomidate; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents; D015742:Propofol; D013610:Tachycardia / Q000209:etiology / Q000503:physiopathology; D013874:Thiopental; D014673:Vecuronium Bromide / Q000031:analogs & derivatives*
D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; C082938:rapacuronium; D013874:Thiopental; D015742:Propofol; D005045:Etomidate