title: Propofol and remifentanil for intubation without muscle relaxant: the effect of the order of injection.
abstract: BACKGROUND
  Common practice in intubation without muscle relaxant is to inject the opioid drug prior to the hypnotic drug. Because remifentanil reaches adequate cerebral concentration more rapidly than does propofol, we tested the hypothesis that injection of remifentanil after propofol might lead to better intubating conditions.
  
  
  METHODS
  Thirty ASA I-II patients scheduled for elective surgery and with no anticipated difficult intubation were enrolled in the study. Five minutes after midazolam 30 microg kg(-1), patients were randomized into two groups: group PR received propofol 2.5 mg kg(-1) followed by remifentanil 1 microg kg(-1), and group RP received remifentanil 1 microg kg(-1) followed by propofol 2.5 mg kg(-1). Intubating conditions were compared using a well-validated score, and continuous arterial pressure was recorded non-invasively.
  
  
  RESULTS
  Compared with group RP, intubating conditions were significantly better in group PR. The mean arterial pressure decrease was more pronounced in group RP.
  
  
  CONCLUSIONS
  We therefore conclude that in premedicated healthy patients with no anticipated risk of difficult intubation, intubating and haemodynamic conditions are better when remifentanil is injected after propofol.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: F
authors.initials: F
authors.lastname: Trabold
authors.forename: M
authors.initials: M
authors.lastname: Casetta
authors.forename: J
authors.initials: J
authors.lastname: Duranteau
authors.forename: P
authors.initials: P
authors.lastname: Albaladejo
authors.forename: J X
authors.initials: JX
authors.lastname: Mazoit
authors.forename: K
authors.initials: K
authors.lastname: Samii
authors.forename: D
authors.initials: D
authors.lastname: Benhamou
authors.forename: P
authors.initials: P
authors.lastname: Sitbon
mesh_terms: D000293:Adolescent; D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D003371:Cough / Q000209:etiology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives; D007442:Intubation, Intratracheal; D007828:Laryngoscopy; D008297:Male; D008874:Midazolam; D009125:Muscle Relaxants, Central; D010880:Piperidines / Q000008:administration & dosage*; D011229:Preanesthetic Medication; D015742:Propofol / Q000008:administration & dosage*; D000077208:Remifentanil; D014827:Vocal Cords / Q000187:drug effects
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D009125:Muscle Relaxants, Central; D010880:Piperidines; D000077208:Remifentanil; D008874:Midazolam; D015742:Propofol