Propofol is superior to thiopental for intubation without muscle relaxants.
OBJECTIVE
To compare intubating conditions and cardiovascular changes following induction of anesthesia and tracheal intubation in patients receiving either lidocaine-remifentanil-propofol or lidocaine-remifentanil-thiopental prior to induction.


METHODS
In a randomized, double-blind study 76 healthy adult patients were assigned to one of two groups: lidocaine 1.5 mg.kg(-1), remifentanil 2 mug.kg(-1) and propofol 2 mg.kg(-1) (Group P) or lidocaine 1.5 mg.kg(-1), remifentanil 2 mug.kg(-1) and thiopental 5 mg.kg(-1) (Group T). Ninety seconds after the administration of the hypnotic agent, laryngoscopy and tracheal intubation were attempted. Intubating conditions were assessed as excellent, good or poor on the basis of ease of ventilation, jaw relaxation, position of the vocal cords, and patient's response to intubation and slow inflation of the tracheal cuff. The mean arterial pressure (MAP) and heart rate (HR) were measured 45 sec after hypnotic agent administration, immediately after tracheal intubation, two and five minutes after intubation.


RESULTS
Excellent intubating conditions were obtained in 84% of Group P patients and 50% of Group T patients (P < 0.05). The percentage decrease from baseline MAP was significantly higher in Group P than in Group T postinduction (27.4% +/- 11.6 vs 21.8% +/- 10.0) and immediately postintubation (19.0% +/- 16.7 vs 11.2% +/- 14.9). The percentage change from baseline HR was significantly higher in Group P than in Group T postinduction (13.8% +/- 9.7 vs 0.5% +/- 12.4), immediately postintubation (8.7% +/- 13.7 vs 2.1% +/- 13.1), and two minutes postintubation (7.04% +/- 14.3 vs 3.5% +/- 14.3).


CONCLUSIONS
Lidocaine-remifentanil-propofol is superior to lidocaine-remifentanil-thiopental for tracheal intubation without muscle relaxants. However, it induces more hypotension and bradycardia.
Taha
Samar
S
Department of Anesthesiology, American University of Beirut Medical Center, P.O. Box 11 0236 Beirut, Beirut, Lebanon. st01@aub.edu.lb
Siddik-Sayyid
Sahar
S
Alameddine
Mahmoud
M
Wakim
Christiane
C
Dahabra
Chadi
C
Moussa
Adib
A
Khatib
Mohammed
M
Baraka
Anis
A
D000293:Adolescent; D000328:Adult; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008012:Lidocaine / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000494:pharmacology; D010880:Piperidines / Q000494:pharmacology; D015742:Propofol / Q000494:pharmacology*; D000077208:Remifentanil; D013874:Thiopental / Q000494:pharmacology*
D018686:Anesthetics, Intravenous; D009125:Muscle Relaxants, Central; D010880:Piperidines; D008012:Lidocaine; D013874:Thiopental; D000077208:Remifentanil; D015742:Propofol