title: Remifentanil with thiopental for tracheal intubation without muscle relaxants.
abstract: Tracheal intubation may be accomplished with remifentanil and a non-opioid IV anesthetic without a muscle relaxant. In this study, we evaluated in double-blinded, prospective, randomized manner the dose requirements for remifentanil with thiopental without muscle relaxant administration to obtain clinically acceptable intubation conditions and cardiovascular responses. After premedication with midazolam 0.03 mg/kg IV, 105 patients were randomized equally to one of three study groups, each receiving the following: remifentanil 2 micro g/kg (Group I), 3 micro g/kg (Group II), and 4 micro g/kg (Group III). Remifentanil was administered over 30 s, and anesthesia was induced with thiopental 5 mg/kg. Tracheal intubation conditions were assessed by the anesthesiologist performing the intubation as: (a) excellent, (b) satisfactory, (c) fair, and (d) unsatisfactory. There were no statistically significant differences among groups regarding to demographic data. Blood pressure and heart rate did not increase in any group after accomplishing intubation. There was a significant improvement in intubation conditions between Groups I and II, I and III, and II and III (P < 0.001). We conclude that remifentanil 4 micro g/kg administered before thiopental 5 mg/kg provided excellent or satisfactory intubation conditions in 94% of patients and prevented cardiovascular responses to intubation.
  
  
  CONCLUSIONS
  We evaluated in a double-blinded manner the dose requirements for remifentanil with thiopental without muscle relaxants for obtaining acceptable intubation condition. Our results show that remifentanil 4 micro g/kg administered before thiopental provided excellent or satisfactory intubation condition in 94% of patients.
authors.affiliation: Department of Anesthesiology, Inonu University, School of Medicine, Malatya, Turkey.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Durmus
authors.forename: Gedik
authors.initials: G
authors.lastname: Ender
authors.forename: But A
authors.initials: BA
authors.lastname: Kadir
authors.forename: Gulhas
authors.initials: G
authors.lastname: Nurcin
authors.forename: Ozturk
authors.initials: O
authors.lastname: Erdogan
authors.forename: M Ozcan
authors.initials: MO
authors.lastname: Ersoy
mesh_terms: D000293:Adolescent; D000328:Adult; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central; D010880:Piperidines; D011229:Preanesthetic Medication; D011446:Prospective Studies; D000077208:Remifentanil; D013874:Thiopental
chemical_list: D018686:Anesthetics, Intravenous; D009125:Muscle Relaxants, Central; D010880:Piperidines; D013874:Thiopental; D000077208:Remifentanil