[Tracheal intubation without muscle relaxants in patients under coronary artery bypass surgery]

ABSTRACT

Although the conventional technique in coronary artery bypass surgery [CABG] consists of using long-acting opioids and muscle relaxants, but in some situation usage of long acting drugs may be hazardous. Administration of remifentanil followed by propofol provides adequate conditions for tracheal intubation without muscle relaxants. This study was performed to evaluate intra thracheal intubation without muscle relaxants in CABG. This double - blind clinical experimental study was done in the cardiosurgery department of Imam Reza Hospital in the year 2004. Intubation conditions and hemodynamic and ST changes in premedicated patients, candidate for CABG surgery was compared. 90 patients with New York heart association class I-II were assigned to one of three groups [n=30]. After prehydration with ringer solution, sufentanil l micro/kg or remifentanil 2 or 4 micro /kg was injected followed by 1.5 mg/kg propofol. Ninety seconds after administration of the propofol, laryngoscopy and intubation were attempted. Intubation conditions were assessed using a four-point scoring system. ST changes, heart rate and mean arterial pressure measured invasively before induction to five minutes thereafter [6 time point]. Data was analyzed using descriptive statistics, chi 2 and T tests, and frequency distribution tables. Tracheal intubation was successful in all patients without any problems. Intubation conditions were also clinically acceptable in all groups. Mean arterial pressure, HR and ST changes were not different between the groups significantly. It is concluded that varying doses [2-4[micro/kg] of remifentanil administered before propofol provides acceptable tracheal intubation condition and hemodynamic changes comparing to conventional technique in patients with coronary artery disease