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Assessment of tracheal intubating conditions in children using remifentanil and propofol without muscle relaxant.
Paediatr Anaesth. 2004 Jun; 14(6):452-6.PA

Abstract

BACKGROUND

Tracheal intubation in children can be achieved by deep inhalational anaesthesia or an intravenous anaesthetic and a muscle relaxant, suxamethonium being widely used despite several side-effects. Studies have shown that oral intubation can be facilitated safely and effectively in children after induction of anaesthesia with propofol and alfentanil without a muscle relaxant. Remifentanil is a new, ultra-short acting, selective mu-receptor agonist that is 20-30 times more potent than alfentanil. This clinical study was designed to assess whether combination of propofol and remifentanil could be used without a muscle relaxant to facilitate tracheal intubation in children.

METHODS

Forty children (5-10 years) admitted for adenotonsillectomy were randomly allocated to one of two groups to receive remifentanil 2 microg.kg(-1) (Gp I) or remifentanil 3 microg.kg(-1) (Gp II) before the induction of anaesthesia with i.v. propofol 3 mg.kg(-1). No neuromuscular blocking agent was administered. Intubating conditions were assessed using a four-point scoring system based on ease of laryngoscopy, jaw relaxation, position of vocal cords, degree of coughing and limb movement. Mean arterial pressure (MAP) and heart rate (HR) measured noninvasively before induction of anaesthesia to 5 min after intubation (seven time points).

RESULTS

Tracheal intubation was successful in all patients without requiring neuromuscular blocking agent. Intubating conditions were clinically acceptable in 10 of 20 patients (50%) in Gp I compared with 18 of 20 patients (90%) in Gp II (P < 0.05). MAP and HR decreased in both groups after induction of anaesthesia (P < 0.01). Both HR and MAP were significantly lower in Gp II compared with Gp I after tracheal intubation (P < 0.01). No patient in the present study developed bradycardia or hypotension.

CONCLUSIONS

We conclude that remifentanil (3 microg.kg(-1)), administered before propofol (3 mg.kg(-1)) provides acceptable tracheal intubating conditions in children, and completely inhibited the increase in HR and MAP associated with intubation.

Authors+Show Affiliations

Department of Anaesthesia and Intensive Care, Al Sabah Hospital, Kuwait. ykbatra@glide.net.inNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15153205

Citation

Batra, Y K., et al. "Assessment of Tracheal Intubating Conditions in Children Using Remifentanil and Propofol Without Muscle Relaxant." Paediatric Anaesthesia, vol. 14, no. 6, 2004, pp. 452-6.
Batra YK, Al Qattan AR, Ali SS, et al. Assessment of tracheal intubating conditions in children using remifentanil and propofol without muscle relaxant. Paediatr Anaesth. 2004;14(6):452-6.
Batra, Y. K., Al Qattan, A. R., Ali, S. S., Qureshi, M. I., Kuriakose, D., & Migahed, A. (2004). Assessment of tracheal intubating conditions in children using remifentanil and propofol without muscle relaxant. Paediatric Anaesthesia, 14(6), 452-6.
Batra YK, et al. Assessment of Tracheal Intubating Conditions in Children Using Remifentanil and Propofol Without Muscle Relaxant. Paediatr Anaesth. 2004;14(6):452-6. PubMed PMID: 15153205.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of tracheal intubating conditions in children using remifentanil and propofol without muscle relaxant. AU - Batra,Y K, AU - Al Qattan,A R, AU - Ali,S S, AU - Qureshi,M I, AU - Kuriakose,D, AU - Migahed,A, PY - 2004/5/22/pubmed PY - 2004/9/3/medline PY - 2004/5/22/entrez SP - 452 EP - 6 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 14 IS - 6 N2 - BACKGROUND: Tracheal intubation in children can be achieved by deep inhalational anaesthesia or an intravenous anaesthetic and a muscle relaxant, suxamethonium being widely used despite several side-effects. Studies have shown that oral intubation can be facilitated safely and effectively in children after induction of anaesthesia with propofol and alfentanil without a muscle relaxant. Remifentanil is a new, ultra-short acting, selective mu-receptor agonist that is 20-30 times more potent than alfentanil. This clinical study was designed to assess whether combination of propofol and remifentanil could be used without a muscle relaxant to facilitate tracheal intubation in children. METHODS: Forty children (5-10 years) admitted for adenotonsillectomy were randomly allocated to one of two groups to receive remifentanil 2 microg.kg(-1) (Gp I) or remifentanil 3 microg.kg(-1) (Gp II) before the induction of anaesthesia with i.v. propofol 3 mg.kg(-1). No neuromuscular blocking agent was administered. Intubating conditions were assessed using a four-point scoring system based on ease of laryngoscopy, jaw relaxation, position of vocal cords, degree of coughing and limb movement. Mean arterial pressure (MAP) and heart rate (HR) measured noninvasively before induction of anaesthesia to 5 min after intubation (seven time points). RESULTS: Tracheal intubation was successful in all patients without requiring neuromuscular blocking agent. Intubating conditions were clinically acceptable in 10 of 20 patients (50%) in Gp I compared with 18 of 20 patients (90%) in Gp II (P < 0.05). MAP and HR decreased in both groups after induction of anaesthesia (P < 0.01). Both HR and MAP were significantly lower in Gp II compared with Gp I after tracheal intubation (P < 0.01). No patient in the present study developed bradycardia or hypotension. CONCLUSIONS: We conclude that remifentanil (3 microg.kg(-1)), administered before propofol (3 mg.kg(-1)) provides acceptable tracheal intubating conditions in children, and completely inhibited the increase in HR and MAP associated with intubation. SN - 1155-5645 UR - https://www.unboundmedicine.com/medline/citation/15153205/Assessment_of_tracheal_intubating_conditions_in_children_using_remifentanil_and_propofol_without_muscle_relaxant_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=1155-5645&amp;date=2004&amp;volume=14&amp;issue=6&amp;spage=452 DB - PRIME DP - Unbound Medicine ER -