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Tracheal intubating conditions using propofol and remifentanil target-controlled infusion: a comparison of remifentanil EC50 for Glidescope and Macintosh.
Eur J Anaesthesiol. 2009 Mar; 26(3):223-8.EJ

Abstract

BACKGROUND AND OBJECTIVE

The combination remifentanil-propofol was used for tracheal intubation without muscle relaxant in patients with anticipated difficult airway. Using a target-controlled infusion, we compared the remifentanil concentrations required for intubation with the Macintosh laryngoscope and the Glidescope, at a constant plasma concentration of propofol without muscle relaxant.

METHODS

Sixty ASA I or II patients were randomly assigned to either the Macintosh or Glidescope group (30 per group). A target-controlled infusion of propofol was used to maintain a predetermined effect-site concentration of 3 microg ml. The target concentration of remifentanil for each patient in a group was determined by the response of the previous patient, using increments or decrements of 0.5 ng ml. Intubation was attempted at 4 min following induction to allow for equilibration between the blood and the effect site. The intubation response was graded as successful or failure by the Helbo-Hansen scoring system. The median effective concentration of remifentanil for tracheal intubation was determined using the probit regression model.

RESULTS

The median effective concentration of remifentanil required for intubation with the Macintosh laryngoscope was 4.41 ng ml (3.13-5.27; 95% confidence interval) and that of the Glidescope was 5.45 ng ml (4.45-6.45; 95% confidence interval; P = 0.083). There was no difference in the total intubation scores. No patients showed signs of muscle rigidity. Arterial pressures or heart rate did not differ between the groups.

CONCLUSION

There is no strong evidence that the target remifentanil concentrations required for adequate intubating conditions differed according to the technique used for intubation in the nonparalysed patient. We did not detect any major complications using this technique for either method.

Authors+Show Affiliations

Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore. drfaraza@yahoo.com.sgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19237984

Citation

Ithnin, F, et al. "Tracheal Intubating Conditions Using Propofol and Remifentanil Target-controlled Infusion: a Comparison of Remifentanil EC50 for Glidescope and Macintosh." European Journal of Anaesthesiology, vol. 26, no. 3, 2009, pp. 223-8.
Ithnin F, Lim Y, Shah M, et al. Tracheal intubating conditions using propofol and remifentanil target-controlled infusion: a comparison of remifentanil EC50 for Glidescope and Macintosh. Eur J Anaesthesiol. 2009;26(3):223-8.
Ithnin, F., Lim, Y., Shah, M., Shen, L., & Sia, A. T. (2009). Tracheal intubating conditions using propofol and remifentanil target-controlled infusion: a comparison of remifentanil EC50 for Glidescope and Macintosh. European Journal of Anaesthesiology, 26(3), 223-8. https://doi.org/10.1097/EJA.0b013e328324b4fc
Ithnin F, et al. Tracheal Intubating Conditions Using Propofol and Remifentanil Target-controlled Infusion: a Comparison of Remifentanil EC50 for Glidescope and Macintosh. Eur J Anaesthesiol. 2009;26(3):223-8. PubMed PMID: 19237984.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tracheal intubating conditions using propofol and remifentanil target-controlled infusion: a comparison of remifentanil EC50 for Glidescope and Macintosh. AU - Ithnin,F, AU - Lim,Y, AU - Shah,M, AU - Shen,L, AU - Sia,A T H, PY - 2009/2/25/entrez PY - 2009/2/25/pubmed PY - 2009/5/2/medline SP - 223 EP - 8 JF - European journal of anaesthesiology JO - Eur J Anaesthesiol VL - 26 IS - 3 N2 - BACKGROUND AND OBJECTIVE: The combination remifentanil-propofol was used for tracheal intubation without muscle relaxant in patients with anticipated difficult airway. Using a target-controlled infusion, we compared the remifentanil concentrations required for intubation with the Macintosh laryngoscope and the Glidescope, at a constant plasma concentration of propofol without muscle relaxant. METHODS: Sixty ASA I or II patients were randomly assigned to either the Macintosh or Glidescope group (30 per group). A target-controlled infusion of propofol was used to maintain a predetermined effect-site concentration of 3 microg ml. The target concentration of remifentanil for each patient in a group was determined by the response of the previous patient, using increments or decrements of 0.5 ng ml. Intubation was attempted at 4 min following induction to allow for equilibration between the blood and the effect site. The intubation response was graded as successful or failure by the Helbo-Hansen scoring system. The median effective concentration of remifentanil for tracheal intubation was determined using the probit regression model. RESULTS: The median effective concentration of remifentanil required for intubation with the Macintosh laryngoscope was 4.41 ng ml (3.13-5.27; 95% confidence interval) and that of the Glidescope was 5.45 ng ml (4.45-6.45; 95% confidence interval; P = 0.083). There was no difference in the total intubation scores. No patients showed signs of muscle rigidity. Arterial pressures or heart rate did not differ between the groups. CONCLUSION: There is no strong evidence that the target remifentanil concentrations required for adequate intubating conditions differed according to the technique used for intubation in the nonparalysed patient. We did not detect any major complications using this technique for either method. SN - 1365-2346 UR - https://www.unboundmedicine.com/medline/citation/19237984/Tracheal_intubating_conditions_using_propofol_and_remifentanil_target_controlled_infusion:_a_comparison_of_remifentanil_EC50_for_Glidescope_and_Macintosh_ L2 - https://doi.org/10.1097/EJA.0b013e328324b4fc DB - PRIME DP - Unbound Medicine ER -