Naziri Freshteh, Amiri Hakimeh Alereza, Rabiee Mozaffar, Banihashem Nadia, Nejad Farhad Mohammad, Shirkhani Ziba, Solimanian Sedigheh
Department of Anesthesiology, Babol University of Medical Sciences, Babol, Mazandaran, Iran.
Saudi J Anaesth. 2015 Oct-Dec;9(4):409-12. doi: 10.4103/1658-354X.159465.
Endotracheal intubation is essential during general anesthesia and muscle relaxant drugs provide ideal conditions for this purpose. The objective of this study was to evaluate the intubating condition of remifentanil combined with propofol without muscle relaxant.
In this prospective randomized study, 60 children aged 3-12 years, American Society of Anesthesiologists physical status I and II were included. All the children were premedicated with 0.05 mg/kg midazolam and 1.5 mg/kg lidocaine 5 min before the induction of anesthesia with 3 mg/kg propofol. Then, they were allocated randomly to receive either 2 μg/kg remifentanil (group R) or 1.5 mg/kg succinylcholine (group S). Tracheal intubation was attempted 90 s after the administration of propofol. The quality of intubation was assessed by using Copenhagen score based on jaw relaxation, ease of laryngoscopy, position of vocal cord, coughing and limb movement. Heart rate and blood pressure were recorded before and after induction, and 1, 3, 5 min after intubation.
There was no significant difference in intubating condition between the two groups (P = 0.11). Intubation condition was excellent in 26 of 30 (86.7%) patients in the group R compared with 30 (100%) patients in the group S. We observed significant difference in heart rate and systolic blood pressure over time between two groups (P = 0.02, P = 0.03 respectively). After intubation, we had higher heart rate and systolic blood pressure with a significant difference in group S compared with group R (P = 0.006, P = 0.018). None of the children had a chest rigidity, laryngospasm, and hypoxia.
In premedicated children, propofol-remifentanil combination provides adequate conditions for tracheal intubation that is comparable with succinylcholine. Hemodynamic response to laryngoscopy and tracheal intubation was controlled better in group R.
气管插管在全身麻醉期间至关重要，肌肉松弛药物为此提供了理想条件。本研究的目的是评估瑞芬太尼联合丙泊酚在无肌肉松弛剂情况下的插管条件。
在这项前瞻性随机研究中，纳入了60名年龄在3至12岁、美国麻醉医师协会身体状况为I级和II级的儿童。所有儿童在使用3mg/kg丙泊酚诱导麻醉前5分钟，预先给予0.05mg/kg咪达唑仑和1.5mg/kg利多卡因。然后，将他们随机分配接受2μg/kg瑞芬太尼（R组）或1.5mg/kg琥珀酰胆碱（S组）。在给予丙泊酚90秒后尝试气管插管。根据下颌松弛、喉镜检查的难易程度、声带位置、咳嗽和肢体运动情况，使用哥本哈根评分评估插管质量。记录诱导前、诱导后以及插管后1、3、5分钟的心率和血压。
两组的插管条件无显著差异（P = 0.11）。R组30例患者中有26例（86.7%）插管条件极佳，而S组为30例（100%）。我们观察到两组之间心率和收缩压随时间存在显著差异（分别为P = 0.02，P = 0.03）。插管后，S组的心率和收缩压高于R组，差异有统计学意义（P = 0.006，P = 0.018）。所有儿童均未出现胸壁强直、喉痉挛和低氧血症。
在预先用药的儿童中，丙泊酚 - 瑞芬太尼组合为气管插管提供了与琥珀酰胆碱相当的充分条件。R组对喉镜检查和气管插管的血流动力学反应控制得更好。
