[Tracheal intubation quality under remifentanil-propofol with sevoflurane compared with remifentanil-propofol with rocuronium: a randomized double-blind clinical trial].
OBJECTIVE
To determine whether intubation conditions under remifentanil-propofol plus sevoflurane rather than a nondepolarizing neuromuscular blocker are similar to those obtained when a neuromuscular blocker is used.


METHODS
In this double-blind controlled trial, 100 patients undergoing outpatient surgery were randomized to 2 groups. Intubation in one group was performed under remifentanil, propofol and sevoflurane. In the other, intubation was performed under remifentanil, propofol, and the nondepolarizing neuromuscular blocker rocuronium. We recorded dysphonia at 24 hours, Cormack-Lehane classification at laryngoscopy, mandibular relaxation, vocal cord position and mobility, and cough or movement during laryngoscopy, on intubation and on cuff inflation. Blood pressure and heart rate before and after tracheal intubation were also recorded.


RESULTS
No significant between-group differences were observed in dysphonia 24 hours after surgery, Cormack-Lehane classification at laryngoscopy, mandibular relaxation, the position or mobility of vocal cords, or cough or movement during laryngoscopy, intubation or cuff inflation. After intubation the mean (SD) systolic blood pressure was 119.7 (75.4) mm Hg in the rocuronium group and 97.5 (54.5) mm Hg in the sevoflurane group. Mean heart rate was 80.7 beats/min in the rocuronium group and 66.7 beats/min in the sevoflurane group. The differences were significant (P < .05).


CONCLUSIONS
Adequate doses of remifentanil, propofol, and sevoflurane provide intubation conditions that are similar to those achieved by using a nondepolarizing neuromuscular blocker, without exposing patients to additional risk. Avoiding use of a neuromuscular blocker would circumvent the development of complications associated with use of these agents or their antagonists and costs would be lower.
González Obregón
M P
MP
Clínica CES, Medellín, Colombia, Sur América. mpgonzalez@ces.edu.co
Rivera Díaz
R C
RC
Ordóñez Molina
J E
JE
Rivera Díaz
J S
JS
Velásquez Ossa
L F
LF
Pineda Ibarra
C
C
Serna Gutiérrez
J
J
Franco Botero
V
V
D000328:Adult; D000732:Androstanols / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D019162:Anesthetics, Combined / Q000008:administration & dosage; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D003371:Cough / Q000209:etiology; D004311:Double-Blind Method; D055154:Dysphonia / Q000209:etiology; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology; D000077208:Remifentanil; D000077123:Rocuronium; D000077149:Sevoflurane
D000732:Androstanols; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D000077123:Rocuronium; D015742:Propofol