title: The effects of sevoflurane with propofol and remifentanil on tracheal intubation conditions without neuromuscular blocking agents.
abstract: BACKGROUND
  Propofol and remifentanil are used for tracheal intubation in the absence of neuromuscular blocking agents. We hypothesized that the addition of sevoflurane to propofol and remifentanil would improve intubation conditions and provide hemodynamic stability.
  
  
  METHODS
  Seventy-six patients scheduled for elective surgery were randomly allocated to be ventilated with either 4% (group I) or 7% sevoflurane (group II) after propofol injection (2 mg/kg). All patients received remifentanil (1 microg/kg) 30 seconds after administration of propofol. Ninety seconds after remifentanil was given, laryngoscopy and tracheal intubation were performed. Intubation conditions and hemodynamic changes were evaluated.
  
  
  RESULTS
  The overall incidence of clinically acceptable intubation conditions was significantly higher in group II (92%) than group I (58%) (P = 0.001). Scores for vocal cord position, coughing, and limb movement were significantly better in group II (P < 0.05). Mean blood pressure remained significantly lower than the pre-induction level throughout the investigation in both groups (P < 0.001), but there was no incidence of bradycardia or hypotension requiring treatment.
  
  
  CONCLUSIONS
  Tracheal intubation without neuromuscular blocking agents can be achieved safely and reliably by adding 7% sevoflurane to propofol (2 mg/kg) and remifentanil (1 microg/kg).
authors.affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Wook Jong
authors.initials: WJ
authors.lastname: Kim
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Choi
authors.forename: Doo Hwan
authors.initials: DH
authors.lastname: Kim
authors.forename: Hye Jeong
authors.initials: HJ
authors.lastname: Seo
authors.forename: Eun Ha
authors.initials: EH
authors.lastname: Suk
authors.forename: Seung Woo
authors.initials: SW
authors.lastname: Ku
authors.forename: Pyung Hwan
authors.initials: PH
authors.lastname: Park