title: Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial.
abstract: BACKGROUND
  Tracheal intubation without muscle relaxants is usually performed with remifentanil and propofol or sevoflurane. Remifentanil 1.0 to 4.0 μg·kg(-1) and propofol 2.0-3.0 mg·kg(-1) or sevoflurane up to 8.0 Vol% provide acceptable, i.e. excellent or good intubating conditions. We hypothesized that sevoflurane 1.0 MAC would provide acceptable intubating conditions when combined with propofol and remifentanil.
  
  
  METHODS
  Eighty-three patients to be intubated were randomised to two groups. The SEVO group received propofol 1.5 mg kg(-1), remifentanil 0.30 μg kg min(-1) and sevoflurane 1.0 MAC; the MR group received the same doses of propofol and remifentanil plus rocuronium 0.45 mg kg(-1). We evaluated intubation and extubation conditions, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS). The vocal cords were examined for injury by videolaryngoscopy before and 24 hours after surgery.
  
  
  RESULTS
  ACCEPTABLE INTUBATING CONDITIONS WERE SEEN MORE FREQUENTLY WITH ROCURONIUM THAN WITH SEVOFLURANE: 97% versus 82%; p = 0.03; the subscore for vocal cords was comparable: 100% versus 98%. MAP before intubation decreased significantly compared with the MAP at baseline to the same extent in both groups; ephedrine IV was given in 15 (SEVO) versus 16 (MR) patients; p = 0.93. BIS at tracheal intubation was 27 (13-65) in the SEVO group, 29 (14-62) in the MR group; p = 0.07. Vocal cord injuries (oedema, haematoma) were similar: 4 patients in each group.
  
  
  CONCLUSIONS
  Overall intubating conditions were better when rocuronium was used; the subscore for vocal cords was comparable. The incidence of side effects was the same in the two groups.
  
  
  BACKGROUND
  ClinicalTrials.Gov: NCT 01591031.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock 18057, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mencke
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock 18057, Germany.
authors.forename: Refa Maria
authors.initials: RM
authors.lastname: Jacobs
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock 18057, Germany.
authors.forename: Susann
authors.initials: S
authors.lastname: Machmueller
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock 18057, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Sauer
authors.affiliation: Department of Otorhinolaryngology, University of Rostock, Rostock, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Heidecke
authors.affiliation: Department of Otorhinolaryngology, University of Rostock, Rostock, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Kallert
authors.affiliation: Department of Otorhinolaryngology, University of Rostock, Rostock, Germany.
authors.forename: Hans Wilhelm
authors.initials: HW
authors.lastname: Pau
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock 18057, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Noeldge-Schomburg
authors.affiliation: Department of Otorhinolaryngology, University of Rostock, Rostock, Germany.
authors.forename: Attila
authors.initials: A
authors.lastname: Ovari
mesh_terms: D000368:Aged; D000732:Androstanols / Q000008:administration & dosage / Q000009:adverse effects; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000009:adverse effects; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D062186:Arterial Pressure / Q000187:drug effects; D056805:Consciousness Monitors; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage* / Q000009:adverse effects; D010880:Piperidines / Q000008:administration & dosage / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D000077208:Remifentanil; D000077123:Rocuronium; D000077149:Sevoflurane; D014827:Vocal Cords / Q000293:injuries
chemical_list: 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
keywords: Intubating conditions; Laryngeal injury; Neuromuscular block; Propofol; Remifentanil; Sevoflurane