Remifentanil-propofol versus dexmedetomidine-propfol for tracheal intubation without muscle relaxants

ABSTRACT

In many clinical situations, the use of muscle relaxants is undesirable. We compared tracheal intubating conditions without the use of muscle relaxants in patients receiving either remifentanil 4 mirco g/kg followed by propofol 2mg/kg or dexmedetomidine 1 mirco g/kg followed by propofol 2mg/kg. Patients and methods: Forty patients were randomly assigned to two groups Group [I] consisted of 20 patients who received remifentanil 4 mirco g/kg followed by propofol 2 mg/kg. Group [II] consisted of 20 patients who received dexmedetomidine 1 mirco g/kg followed propofol 2 mg/kg. Ninty sconds after propofol administration, laryngoscopy and tracheal intubation were attempted. Intubating conditions were assessed as excellent, good or poor according to jaw relaxation, laryngoscopy, position of the vocal cords, and patients response to intubation and inflation of endotracheat tube cuff. Excellent intubating conditions [jaw relaxed, vocal cords open and no movement in response to tracheal intubation and cuff inflation] were observed in 95% of patients in remifentanil group while it was oberved in 50% of patients in dexmedetomidine group. Good intubating conditions were observed in 25% of patients in dexmedetomidine group. The remaining 25% of patients in the dexmedetomidine group could not be intubated while in remifentanil group only one patients could not be intubated [5%]. No patients needed treatment for bradycardia or hypotension in remifentanil group while 50% of patients in dexmedetomidine group needed treatment for either bradycardia or hypotension. Tracheal intubating conditions were significantly better and the number of patients showing excellent intubatting conditions was significantly higher in patients who received remifentanil compared to those who received dexmedetomidine