Dose of alfentanil needed to obtain optimal intubation conditions during rapid-sequence induction of anaesthesia with thiopentone and rocuronium.
BACKGROUND
The primary aim of the present study was to determine the dose of alfentanil that must be added to a rapid-sequence induction (RSI) regimen using thiopentone and rocuronium to obtain optimal intubation conditions in >95% of the individuals.


METHODS
A total of 60 ASA I patients were randomly allocated to five different alfentanil dose groups (0, 15, 30, 45, or 60 microg kg-1). A blinded dose of alfentanil followed by thiopentone 4 mg kg-1 and rocuronium 1 mg kg-1 was administered in rapid succession, and tracheal intubation was attempted 40 s thereafter. The relationship between the alfentanil dose and the probability of optimal intubation conditions was determined by non-linear logistic regression analysis. Blood pressure (BP) changes were recorded continuously using an intra-arterial catheter.


RESULTS
The success rate of optimal intubation conditions increased with increasing doses of alfentanil. The alfentanil dose needed to obtain optimal intubation conditions in >95% of the patients was 36.4 (CI 33.4-39.4) microg kg-1. In 12 patients, the systolic BP declined to <90 mm Hg during the 3 min immediately after intubation.


CONCLUSIONS
Adding 36-40 microg kg-1 alfentanil to a regimen of thiopentone and rocuronium during RSI of anaesthesia may significantly increase the success rate of optimal intubation conditions. Significant hypotension requiring vasopressor treatment may occur.
Abou-Arab
M H
MH
Department of Anesthesia, Aker University Hospital, Oslo, Norway.
Heier
T
T
Caldwell
J E
JE
D000293:Adolescent; D000328:Adult; D015760:Alfentanil / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000732:Androstanols; D000771:Anesthesia, Intravenous / Q000379:methods*; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium; D013874:Thiopental
D000701:Analgesics, Opioid; D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D015760:Alfentanil; D013874:Thiopental; D000077123:Rocuronium