Optimal remifentanil dose for lightwand intubation without muscle relaxants in healthy patients with thiopental coadministration:  a prospective randomised study.
BACKGROUND
Muscle relaxants used to facilitate tracheal intubation have disadvantages.


OBJECTIVE
This study was designed to evaluate the dose requirements for remifentanil combined with thiopental for optimal lightwand intubation without muscle relaxants.


METHODS
Prospective randomised controlled study.


METHODS
A tertiary care teaching hospital.


METHODS
Ninety-six patients requiring general anaesthesia for elective surgery.


METHODS
Patients received remifentanil 1, 2, or 3 μg kg(-1) (group R1, R2, R3, each n = 32) as a slow bolus infusion over 60 s, followed by thiopental 5 mg kg(-1). Ninety seconds after remifentanil administration, lightwand intubation was attempted and intubation time was recorded. Intubating conditions were considered excellent if there was no patient movement or cough, good if coughing occurred once or twice after intubation and poor if persistent movement or cough occurred after intubation. Excellent or good intubating conditions were regarded as clinically acceptable. The duration of apnoea was recorded.


METHODS
Intubating conditions and the duration of apnoea.


RESULTS
Lightwand intubation was successful at the first attempt in all patients except for two in group R1. The intubating conditions were more acceptable in groups R2 and R3 than in group R1 (97 and 100 vs. 63%, P < 0.01). Intubation time was shorter in group R3 than in group R1 (22 ± 8 vs. 33 ± 18 s, P < 0.01). There was no significant difference in intubation time and conditions between groups R2 and R3. The mean duration of apnoea was prolonged in group R3 compared with group R2 (10.2 ± 2.1 vs. 4.6 ± 1.6 min, P < 0.01).


CONCLUSIONS
Our results suggest that remifentanil 2 or 3 μg kg(-1) combined with thiopental 5 mg kg provides acceptable conditions for lightwand intubation without muscle relaxants. Spontaneous ventilation returns more rapidly following remifentanil 2 μg kg(-1) than with remifentanil 3 μg kg(-1).
Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Young-Tae
YT
Jeon
Ah-Young
AY
Oh
Sang-Heon
SH
Park
Jung-Won
JW
Hwang
Hee-Pyoung
HP
Park
D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000627:therapeutic use; D001049:Apnea / Q000209:etiology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D000077208:Remifentanil; D013874:Thiopental / Q000008:administration & dosage* / Q000627:therapeutic use; D013997:Time Factors
D018686:Anesthetics, Intravenous; D010880:Piperidines; D013874:Thiopental; D000077208:Remifentanil