Stevens J B, Wheatley L
Department of Anesthesiology, Brooke Army Medical Center, San Antonio, Texas 78234, USA.
Anesth Analg. 1998 Jan;86(1):45-9. doi: 10.1097/00000539-199801000-00009.
Using alfentanil followed by an anesthetic induction dose of propofol provides adequate conditions for tracheal intubation without neuromuscular relaxants. Remifentanil, which has a clinical onset similar to that of alfentanil, has not been investigated for this indication. Accordingly, 80 ASA physical status I and II premedicated outpatients were randomly assigned to one of four groups (n = 20/group). Remifentanil 1, 2, 3, or 4 micrograms/kg (Groups I-IV, respectively) was infused intravenously over 90 s. Sixty seconds after beginning the remifentanil infusion, propofol 2 mg/kg was infused over 5 s. Ninety seconds after the administration of propofol, laryngoscopy and tracheal intubation were attempted and graded. Clinically acceptable intubating conditions (i.e., jaw relaxed, vocal cords open, and fewer than two coughs in response to intubation) were observed in 35%, 75%, 100%, and 95% of patients in Groups I-IV, respectively. Clinically acceptable intubating conditions were significantly (P < 0.05) less likely to occur in Group I compared with all other groups. Excellent intubating conditions (i.e., vocal cords open, no movement in response to intubation) were observed in 30%, 50%, 80%, 80% of patients in Groups I-IV, respectively. Overall conditions at intubation were significantly (P < 0.05) better in Groups III and IV compared with Groups I and II. The mean time to resumption of spontaneous ventilation after induction was < 5 min in all groups. No patient manifested clinically significant muscle rigidity. The mean arterial pressure decreased 16%, 20%, 28%, 26% immediately before tracheal intubation in Groups I-IV, respectively. No patient was treated for hypotension or bradycardia. In conclusion, healthy, premedicated patients with favorable airway anatomy can be reliably intubated with good or excellent conditions 90 s after the administration of remifentanil 3-4 micrograms/kg and propofol 2 mg/kg.
Remifentanil 3 micrograms/kg and propofol 2 mg/kg co-administered intravenously may reliably provide adequate conditions for tracheal intubation in healthy patients without neuromuscular relaxants. This combination of drugs may allow the rapid return of spontaneous ventilation.
使用阿芬太尼后给予诱导剂量的丙泊酚，无需使用神经肌肉阻滞剂即可为气管插管提供充分条件。瑞芬太尼的临床起效时间与阿芬太尼相似，但尚未针对此适应证进行研究。因此，80例美国麻醉医师协会（ASA）身体状况为Ⅰ级和Ⅱ级且已接受术前用药的门诊患者被随机分为四组（每组n = 20）。分别在90秒内静脉输注瑞芬太尼1、2、3或4微克/千克（分别为Ⅰ - Ⅳ组）。在开始输注瑞芬太尼60秒后，在5秒内输注丙泊酚2毫克/千克。给予丙泊酚90秒后，尝试进行喉镜检查和气管插管并分级。Ⅰ - Ⅳ组患者中分别有35%、75%、100%和95%观察到临床上可接受的插管条件（即下颌松弛、声带张开且插管时咳嗽少于两次）。与所有其他组相比，Ⅰ组临床上可接受的插管条件发生的可能性显著降低（P < 0.05）。Ⅰ - Ⅳ组患者中分别有30%、50%、80%、80%观察到极佳的插管条件（即声带张开、插管时无动作）。与Ⅰ组和Ⅱ组相比，Ⅲ组和Ⅳ组插管时的总体条件显著更好（P < 0.05）。所有组诱导后恢复自主通气的平均时间均<5分钟。没有患者表现出临床上明显的肌肉强直。Ⅰ - Ⅳ组在气管插管前即刻平均动脉压分别下降16%、20%、28%、26%。没有患者因低血压或心动过缓接受治疗。总之，对于气道解剖结构良好、已接受术前用药的健康患者，在给予3 - 4微克/千克瑞芬太尼和2毫克/千克丙泊酚90秒后，可可靠地进行气管插管且条件良好或极佳。
静脉联合使用3微克/千克瑞芬太尼和2毫克/千克丙泊酚可为无神经肌肉阻滞剂的健康患者可靠地提供气管插管的充分条件。这种药物组合可能使自主通气迅速恢复。
