title: Endotracheal intubation without muscle relaxants in children using remifentanil and propofol: Comparative study.
abstract: BACKGROUND
  Endotracheal intubation is essential during general anesthesia and muscle relaxant drugs provide ideal conditions for this purpose. The objective of this study was to evaluate the intubating condition of remifentanil combined with propofol without muscle relaxant.
  
  
  METHODS
  In this prospective randomized study, 60 children aged 3-12 years, American Society of Anesthesiologists physical status I and II were included. All the children were premedicated with 0.05 mg/kg midazolam and 1.5 mg/kg lidocaine 5 min before the induction of anesthesia with 3 mg/kg propofol. Then, they were allocated randomly to receive either 2 μg/kg remifentanil (group R) or 1.5 mg/kg succinylcholine (group S). Tracheal intubation was attempted 90 s after the administration of propofol. The quality of intubation was assessed by using Copenhagen score based on jaw relaxation, ease of laryngoscopy, position of vocal cord, coughing and limb movement. Heart rate and blood pressure were recorded before and after induction, and 1, 3, 5 min after intubation.
  
  
  RESULTS
  There was no significant difference in intubating condition between the two groups (P = 0.11). Intubation condition was excellent in 26 of 30 (86.7%) patients in the group R compared with 30 (100%) patients in the group S. We observed significant difference in heart rate and systolic blood pressure over time between two groups (P = 0.02, P = 0.03 respectively). After intubation, we had higher heart rate and systolic blood pressure with a significant difference in group S compared with group R (P = 0.006, P = 0.018). None of the children had a chest rigidity, laryngospasm, and hypoxia.
  
  
  CONCLUSIONS
  In premedicated children, propofol-remifentanil combination provides adequate conditions for tracheal intubation that is comparable with succinylcholine. Hemodynamic response to laryngoscopy and tracheal intubation was controlled better in group R.
authors.affiliation: Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran.
authors.forename: Freshteh
authors.initials: F
authors.lastname: Naziri
authors.affiliation: Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran.
authors.forename: Hakimeh Alereza
authors.initials: HA
authors.lastname: Amiri
authors.affiliation: Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran.
authors.forename: Mozaffar
authors.initials: M
authors.lastname: Rabiee
authors.affiliation: Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran.
authors.forename: Nadia
authors.initials: N
authors.lastname: Banihashem
authors.affiliation: Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran.
authors.forename: Farhad Mohammad
authors.initials: FM
authors.lastname: Nejad
authors.affiliation: Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran.
authors.forename: Ziba
authors.initials: Z
authors.lastname: Shirkhani
authors.affiliation: Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran.
authors.forename: Sedigheh
authors.initials: S
authors.lastname: Solimanian
keywords: Endotracheal intubation condition; propofol; remifentanil; succinylcholine