title: Propofol is superior to thiopental for intubation without muscle relaxants.
abstract: 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.
authors.affiliation: Department of Anesthesiology, American University of Beirut Medical Center, P.O. Box 11 0236 Beirut, Beirut, Lebanon. st01@aub.edu.lb
authors.forename: Samar
authors.initials: S
authors.lastname: Taha
authors.forename: Sahar
authors.initials: S
authors.lastname: Siddik-Sayyid
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Alameddine
authors.forename: Christiane
authors.initials: C
authors.lastname: Wakim
authors.forename: Chadi
authors.initials: C
authors.lastname: Dahabra
authors.forename: Adib
authors.initials: A
authors.lastname: Moussa
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khatib
authors.forename: Anis
authors.initials: A
authors.lastname: Baraka
mesh_terms: 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*
chemical_list: D018686:Anesthetics, Intravenous; D009125:Muscle Relaxants, Central; D010880:Piperidines; D008012:Lidocaine; D013874:Thiopental; D000077208:Remifentanil; D015742:Propofol