Remifentanil with propofol or thiopental for tracheal intubation without muscle relaxants

ABSTRACT

This study designed to evaluate the use remifentanil followed by propofol or thiopental without muscle relaxants for endotracheal intubation compared to thiopental followed by succinylcholine as a control group for obtaining clinically acceptable intubation conditions and hemodynamic changes. We studied 90 healthy children [ASA I-II], aged three to nine years presenting for elective ENT-surgery. The children were enrolled into three equal groups Group A received remifentanil 3 micro g/kg followed by 2.5 mg/kg propofol. Group B received remifentanil 3micro/kg followed by 5 mg/kg thiopental, and Group C as a control group received 5mg thiopental followed by succinylcholine 1.5 mg/kg. The tracheal intubating conditions were considered excellent in 30[100%] of children in Group C, 27[90%] in Groups A and 24 [80%] in Group B. Mask ventilation done easily in all children and complete jaw relaxation in 93.3% of children in Group A, 86.6% in Group B and 100% in Group C [significant difference between Group B and C P<0.05]. All children intubated easily, and slight cord movement in 10% of children in Group A and in 20% in Group B [significant difference between Group A and C P<0.05 and a highly significant difference between Group B and C P<0.001]. 6.66% of children in Group A and 20% in Group B developed slight coughing at intubation [a highly significant difference between Group B and C P<0.001]. As regard the MAP changes after induction and intubation In Group C there was significant difference [P<0.05] between Group C and B and a very highly significant difference [P<0.0001] between group A and C. The heart rate decreased 14% and 2% in the remifentanil groups A and B respectively [P<0.05] arid remained lower than baseline throughout the study. The heart rate increased in group C after induction and intubation and there was significant difference [P<0.05] between Group C and B while the difference in heart rate was very highly significant difference [P<0.0001] between group A and C. In summary, the administration of 2.5 mg/kg propofol or 5mg/kg thiopental and 3.0 microg/kg remifentanil provided clinically acceptable conditions for tracheal intubation and stable hemodynamic in children pretreated with atropine. With this combination of drugs, the return of spontaneous ventilation was as rapid as after thiopental/ succinylcholine with acceptable hemodynamic changes. This technique may be advantageous in children with normal airway anatomy undergoing elective brief surgical procedures or in cases in which neuromuscular block is contraindicated