title: Concentration of remifentanil needed for tracheal intubation with sevoflurane at 1 MAC in adult patients.
abstract: OBJECTIVE
  Inhalation induction with sevoflurane provides acceptable conditions for tracheal intubation. Opioids significantly decrease the alveolar concentration needed to achieve tracheal intubation. The purpose of this study was to determine the target concentration of remifentanil providing excellent conditions for tracheal intubation with sevoflurane at 1 minimum alveolar concentration without muscle relaxant.
  
  
  METHODS
  Twenty-four consecutive patients, aged 18-50 yr, ASA I or II, were studied. Induction of anaesthesia was performed with sevoflurane at age-adjusted minimum alveolar concentration. Remifentanil was simultaneously administered using target-controlled infusion with the Minto model. Target plasma concentration of remifentanil was selected for each patient according to an up-and-down method.
  
  
  RESULTS
  The mean target concentration of remifentanil for successful tracheal intubation was 3.3 ng mL(-1) (95% confidence interval: 2.6-3.9 ng mL(-1)). Arterial pressure, heart rate and bispectral index did not increase after tracheal intubation in the group of patients with successful intubation.
  
  
  CONCLUSIONS
  Remifentanil at 3.3 ng mL(-1) together with sevoflurane at 1 minimum alveolar concentration provides excellent conditions for tracheal intubation in 50% of patients.
authors.affiliation: Centre Hospitalier Universitaire Pellegrin, Département d'Anesthésie-Réanimation I, Bordeaux, France. francois.sztark@chu-bordeaux.fr
authors.forename: F
authors.initials: F
authors.lastname: Sztark
authors.forename: F
authors.initials: F
authors.lastname: Chopin
authors.forename: A
authors.initials: A
authors.lastname: Bonnet
authors.forename: A M
authors.initials: AM
authors.lastname: Cros
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D000077208:Remifentanil; D000077149:Sevoflurane
chemical_list: D000701:Analgesics, Opioid; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil