Excellent intubating conditions with remifentanil-propofol and either low-dose rocuronium or succinylcholine.
OBJECTIVE
The shortest time to tracheal intubation, the best intubating conditions, and the shortest duration of muscle paralysis are achieved with succinylcholine. During a lidocaine-remifentanil-propofol induction of anesthesia, we compared intubating conditions 90 s after administering low-dose rocuronium (0.3 mg . kg(-1)) with intubating conditions 60 s after administering succinylcholine 1.5 mg . kg(-1).


METHODS
The randomized double-blind study included 184 healthy adult patients scheduled for elective surgery. Anesthesia was induced in all patients with lidocaine 1.5 mg . kg(-1), remifentanil 2 microg . kg(-1), and propofol 2 mg . kg(-1) administered over 30 s. In one group, rocuronium 0.3 mg . kg(-1) was administered before the induction sequence, and in the other group, succinylcholine 1.5 mg . kg(-1) was administered after the induction sequence. Laryngoscopy was attempted 90 s after rocuronium administration and 60 s after succinylcholine administration. Intubating conditions were assessed as excellent, good, or poor on the basis of ease of laryngoscopy, position of the vocal cords, and reaction to insertion of the tracheal tube and cuff inflation.


RESULTS
There were 92 patients per group. In the rocuronium group, intubating conditions were excellent in 83 patients (90%), good in 8 (9%), and poor in 1 (1%), not significantly different from the intubating conditions in the succinylcholine group, which were excellent in 88 patients (96%), good in 3 (3%), and poor in 1 (1%) (P = 0.3).


CONCLUSIONS
During a lidocaine-remifentanil-propofol induction of anesthesia, rocuronium 0.3 mg . kg(-1) administered before the induction sequence provides intubating conditions comparable to those achieved with succinylcholine 1.5 mg . kg(-1) administered after the induction sequence.
Department of Anesthesiology, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon.
Sahar M
SM
Siddik-Sayyid
Samar K
SK
Taha
Ghassan E
GE
Kanazi
Jules-Marie A
JM
Chehade
Reine A
RA
Zbeidy
Achir A
AA
Al Alami
Badri W
BW
Zahreddine
Mohamad F
MF
Khatib
Anis S
AS
Baraka
Marie T
MT
Aouad
D000293:Adolescent; D000328:Adult; D000732:Androstanols / Q000008:administration & dosage / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods; D008012:Lidocaine / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D010880:Piperidines / Q000627:therapeutic use; D015742:Propofol / Q000627:therapeutic use; D011446:Prospective Studies; D000077208:Remifentanil; D000077123:Rocuronium; D013390:Succinylcholine / Q000008:administration & dosage / Q000627:therapeutic use*; D014827:Vocal Cords / Q000378:metabolism; D055815:Young Adult
D000732:Androstanols; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D008012:Lidocaine; D013390:Succinylcholine; D000077208:Remifentanil; D000077123:Rocuronium; D015742:Propofol