title: Intubation conditions in young infants after propofol and remifentanil induction with and without low-dose rocuronium.
abstract: BACKGROUND
  Bolus injections of intravenous propofol and remifentanil can be used in the tracheal intubation of infants and children, but relatively large doses are needed. We hypothesised that addition of a small bolus of rocuronium would ensure good intubation conditions when modest propofol and remifentanil doses were used.
  
  
  METHODS
  Seventy infants between 3 weeks and 4 months of age were randomised to receive either placebo or rocuronium. Anaesthesia was induced with IV propofol, 3 (3-5) mg/kg [median (range)]. Rocuronium (0.2 mg/kg) or placebo was then injected, followed 15 s later by 2 μg/kg remifentanil. One anaesthetist attempted tracheal intubation 1 min after the rocuronium/placebo injection and used the 'Copenhagen scoring system' to assess intubation conditions. The neuromuscular effect of 0.2 mg/kg rocuronium was recorded in another eight, already intubated, infants using thumb accelerometry during train-of-four stimulation of the ulnar nerve.
  
  
  RESULTS
  Intubation conditions were classified as 'poor' in 14 of 34 (41%) patients given placebo and in 10 of 36 (28%) patients given rocuronium (P = 0.32). There were four failed first attempts at intubation in the placebo group and none in the rocuronium group (P = 0.051). Maximum neuromuscular depression occurred 4 (3-8) after injection of 0.2 mg/kg rocuronium.
  
  
  CONCLUSIONS
  Intubation conditions were poor in almost one third of the patients receiving propofol-remifentanil. Adding a low-dose rocuronium did not significantly improve intubation conditions.
authors.affiliation: Department of Paediatric Anaesthesia and Intensive Care, Children's Hospital, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Gelberg
authors.forename: L
authors.initials: L
authors.lastname: Kongstad
authors.forename: O
authors.initials: O
authors.lastname: Werner
mesh_terms: D000732:Androstanols / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D003371:Cough / Q000209:etiology; D004357:Drug Synergism; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D007828:Laryngoscopy; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D010880:Piperidines / Q000008:administration & dosage* / Q000494:pharmacology; D011229:Preanesthetic Medication; D015742:Propofol / Q000008:administration & dosage* / Q000494:pharmacology; D000077208:Remifentanil; D000077123:Rocuronium; D017211:Treatment Failure; D014827:Vocal Cords / Q000502:physiology
chemical_list: D000732:Androstanols; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D008012:Lidocaine; D000077208:Remifentanil; D008874:Midazolam; D000077123:Rocuronium; D015742:Propofol