Department of Anaesthesiology and Intensive Care, Toulouse University Hospital, Avenue Jean Poulhès, 31432, Toulouse, France.
Laboratory of Medical and Clinical Pharmacology, Pharmacoepidemiology, Inserm U1027, Toulouse University, Faculty of Medicine, Toulouse, France.
Anaesthesist. 2020 Apr;69(4):262-269. doi: 10.1007/s00101-020-00739-0. Epub 2020 Feb 28.
The aim of this study was to compare tracheal intubation conditions after induction of anesthesia with a bolus of propofol-sufentanil or propofol-remifentanil and a rapid induction technique.
A total of 70 patients (American Society of Anesthesiologists (ASA) classification I‑II) undergoing outpatient surgery under general anesthesia with intubation for tooth extraction were randomly assigned to two groups in this double-blind study. Patients received either a bolus of remifentanil (3 μg/kg) or sufentanil (0.3 μg/kg) together with 2.5 mg/kg propofol for intubation. The primary outcome was the percentage of excellent intubation conditions and the secondary outcomes were the percentage of patients with a decrease of over 20% in mean arterial pressure (MAP) or heart rate (HR), time to achieve spontaneous respiration, time between the end of surgery and extubation and time to achieve an Aldrete score of 10. VAS pain score was >3 or having laryngeal pain 15 min after arriving in the postanesthesia care unit (PACU) were also analyzed.
Intubating conditions (perfect + good conditions) were significantly better with remifentanil than with sufentanil (88.5% vs. 68.6%; p = 0.01). When using remifentanil, the hemodynamic conditions were good. Using remifentanil did not significantly increase the pain score or the laryngeal pain in the recovery room. This was confirmed by no significant differences between the groups for morphine consumption. Remifentanil significantly decreased the time to achieve an Aldrete score of 10.
When intubation without muscle relaxants is required, intubating conditions are much better when a remifentanil bolus is used compared to a sufentanil bolus. The remifentanil/propofol rapid induction technique is a valuable technique to quickly intubate and achieve good conditions.
本研究旨在比较在麻醉诱导时给予依托咪酯-舒芬太尼或依托咪酯-瑞芬太尼负荷量以及快速诱导技术后气管插管条件。
本双盲研究纳入了 70 例（美国麻醉医师协会 [ASA] 分级 I-II）接受全身麻醉下门诊手术并需要插管拔牙的患者，将其随机分为两组。患者接受瑞芬太尼（3μg/kg）或舒芬太尼（0.3μg/kg）联合 2.5mg/kg 依托咪酯负荷量用于插管。主要结局为优秀插管条件的百分比，次要结局为平均动脉压（MAP）或心率（HR）下降超过 20%、自主呼吸恢复时间、手术结束到拔管时间以及达到 Aldrete 评分 10 分的时间。还分析了术后疼痛评分（VAS）>3 分或到达麻醉后恢复室（PACU）后 15 分钟时存在喉痛的患者比例。
与舒芬太尼相比，瑞芬太尼的插管条件（完美+良好条件）显著更好（88.5%比 68.6%；p=0.01）。使用瑞芬太尼时，血流动力学条件良好。使用瑞芬太尼不会显著增加恢复室的疼痛评分或喉痛，两组之间吗啡消耗量无显著差异证实了这一点。瑞芬太尼显著缩短了达到 Aldrete 评分 10 分的时间。
在需要无肌松剂插管时，与舒芬太尼相比，使用瑞芬太尼负荷量时插管条件要好得多。瑞芬太尼/依托咪酯快速诱导技术是一种快速插管并获得良好条件的有价值技术。
