Abstract
Purpose: To compare the intubating conditions after remifentanil-propofol with those after propofol-rocuronium combination with the aim of determining the optimal dose of remifentanil.
Methods: In a randomized, double-blind study 80 healthy children aged three to nine years were assigned to one of four groups (n=20): 2 or 4 µg·kg−1 remifentanil (Re2 or Re4); 2 µg·kg−1 remifentanil and 0.2 mg·kg−1 rocuronium (Re2-Ro0.2); 0.4 mg·kg−1 rocuronium (Ro0.4). After atropine, remifentanil was injected over 30 sec followed by 3.5 mg·kg−1 propofol and rocuronium. After 60 sec, laryngoscopy and intubation were attempted. Intubating conditions were assessed as excellent, good or poor based on ease of ventilation, jaw relaxation, position of the vocal cords, and coughing to intubation.
Results: In all children intubation was successful. Overall intubating conditions were better (P<0.01), and the frequency of excellent conditions, 85%, was higher (P<0.01) in the Re4 group than in the Ro0.4 group. No child manifested signs of muscular rigidity. In the remifentanil groups, arterial pressure decreased 11–13% and heart rate 6–9% after anesthetic induction, and remained at that level throughout the study.
Conclusion: The best intubating conditions were produced by the combination of 4 µg·kg−1 remifentanil and 3.5 mg·kg−1 propofol. It provided excellent or good intubating conditions in all children without causing undue cardiovascular depression.
Résumé
Objectif: Comparer les conditions d’intubation après l’usage d’une combinaison de rémifentanil-propofol avec celles d’une combinaison de propofol-rocuronium dans le but de déterminer la dose optimale de rémifentanil.
Méthode: Lors d’une étude randomisée et à double insu, 80 enfants en bonne santé, de trois à neuf ans, ont été répartis en quatre groupes (n=20) et ont reçu: 2 ou 4 µg·kg−1 de rémifentanil (Ré2 ou Ré4); 2 µg·kg−1 de rémifentanil et 0,2 mg·kg−1 de rocuronium (Ré2-Ro0,2); 0,4 mg·kg−1 de rocuronium. Après l’administration d’atropine, le rémifentanil a été injecté pendant 30 s et a été suivi de 3,5 mg·kg−1 de propofol et de rocuronium. La laryngoscopie et l’intubation ont été tentées après 60 s. Les conditions d’intubation ont été évaluées comme excellentes, bonnes ou pavures selon la facilité de la ventilation, la relaxation de la mâchoire, la position des cordes vocales et la toux pendant l’intubation.
Résultats: L’intubation a été réussie chez tous les enfants. Les conditions générales d’intubation ont été meilleures (P<0,01), et la fréquence d’excellentes conditions, 85 %, plus élevée (P<0,01) dans le groupe Ré4 que dans le groupe Ro0,4. Aucun enfant n’a manifesté de signe de rigidité musculaire. Dans les groupes rémifentanil, la tension artérielle a baissé de 11–13% et la fréquence cardiaque de 6–9% après l’induction de l’anesthésie et sont demeurées à ce niveau tout au long de l’étude.
Conclusion: Les meilleures conditions d’intubation ont été réalisées avec la combinaison de 4 µg·kg−1 de rémifentanil et de 3,5 mg·kg−1 de propofol. L’intubation a été bonne ou excellente chez tous les enfants sans causer de dépression cardiovasculaire indue.
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Klemola, UM., Hiller, A. Tracheal intubation after induction of anesthesia in children with propofol — remifentanil or propofol-rocuronium. Can J Anaesth 47, 854–859 (2000). https://doi.org/10.1007/BF03019664
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DOI: https://doi.org/10.1007/BF03019664