Is alfentanil, prpofol combination better than suxamethonium, propofol for tracheal intubation

Sixty ASA physical status I and II, premedicated patients who undergo day case surgery, were allocated at random into two groups to receive propofol 2.5 mg/kg followed by alfentanil 40 ug/kg [group I], or suxamethonium 1 mg/kg [group II], as a rapid bolus. One minute after study drug administration, tracheal intubation was performed. Intubation conditions were then scored as excellent, good or poor according to ease of laryngoscopy, position of vocal cord, coughing, jaw relaxation, limb movement. The mean arterial pressure [MAP] and heart rate [HR] were also monitored. The postoperative myalgia was assessed.There were no significant differences in the overall assessment of intubating conditions between the two groups. Alfentanil attenuated the haemodynamic responses to tracheal intubation. The occurrence of postoperative myalgia was significantly high in group [II], but in group [I] no cases were reported. We concluded that alfentanil 40 ug/kg in combination with propofol 2.5mg/kg is better than suxamethonium 1 mg/kg for intubation for its haemodynamic stability and avoidance of postoperative myalgia

Cardiovascular effects of mivacurium Experimental and clinical evaluation

Mivacurium, in a dose of 0.2 mg / kg body weight, produced a transient decrease in blood pressure [BP] and a transient increase in heart rate [HR] in anaesthetized cats. Mivacurium antagonized the hypotensive effect of acetylcholine [Ach] on PB and also antagonized the negative inotropic and chronotropic effects of Ach on isolated rabbit's heart. Meanwhile, mivacurium potentiated the hypertensive effect of adrenaline on BP and also the positive inotropic and chronotropic effects of adrenaline on isolated rabbit's heart. A clinical study was performed on forty adult surgical patients who received 0.2 mg / kg body weight mivacurium as a loading fast dose, then neuromuscular blockade was maintained either by a bolus dose of 0.06 mg / kg body weight in 20 patients, or by continuous infusion of 4 - 8 micro g / kg /min in another group of 20 patients whenever T1 returned. There was a brief transient decrease in the mean arterial pressure [MAP] and an increase in HR lasting for 1-3 minutes, but there was no significant change in MAP or HR after the second bolus dose or continuous infusion. The hemodynamic changes with mivacurium suggested histamine release. To conclude, mivacurium can be considered a safe drug in absence of clinically significant alterations in HR and MAP from baseline