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Intubation conditions in young infants after propofol and remifentanil induction with and without low-dose rocuronium.
Acta Anaesthesiol Scand. 2014 Aug; 58(7):820-5.AA

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+Show Affiliations

Department of Paediatric Anaesthesia and Intensive Care, Children's Hospital, Skane University Hospital, Lund University, Lund, Sweden.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

24903522

Citation

Gelberg, J, et al. "Intubation Conditions in Young Infants After Propofol and Remifentanil Induction With and Without Low-dose Rocuronium." Acta Anaesthesiologica Scandinavica, vol. 58, no. 7, 2014, pp. 820-5.
Gelberg J, Kongstad L, Werner O. Intubation conditions in young infants after propofol and remifentanil induction with and without low-dose rocuronium. Acta Anaesthesiol Scand. 2014;58(7):820-5.
Gelberg, J., Kongstad, L., & Werner, O. (2014). Intubation conditions in young infants after propofol and remifentanil induction with and without low-dose rocuronium. Acta Anaesthesiologica Scandinavica, 58(7), 820-5. https://doi.org/10.1111/aas.12346
Gelberg J, Kongstad L, Werner O. Intubation Conditions in Young Infants After Propofol and Remifentanil Induction With and Without Low-dose Rocuronium. Acta Anaesthesiol Scand. 2014;58(7):820-5. PubMed PMID: 24903522.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intubation conditions in young infants after propofol and remifentanil induction with and without low-dose rocuronium. AU - Gelberg,J, AU - Kongstad,L, AU - Werner,O, Y1 - 2014/06/05/ PY - 2014/04/16/accepted PY - 2014/6/7/entrez PY - 2014/6/7/pubmed PY - 2015/3/31/medline SP - 820 EP - 5 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 58 IS - 7 N2 - 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. SN - 1399-6576 UR - https://www.unboundmedicine.com/medline/citation/24903522/Intubation_conditions_in_young_infants_after_propofol_and_remifentanil_induction_with_and_without_low_dose_rocuronium_ L2 - https://doi.org/10.1111/aas.12346 DB - PRIME DP - Unbound Medicine ER -