Tracheal intubation without muscle relaxant using remifentanil and propofol.

Objectives: To assess tracheal intubation conditions after induction of anaesthesia with remifentanil and propofol, using itemized scoring criteria. Study design: Clinical, prospective, open, non comparative trial. Patients: One hundred consecutive patients undergoing surgery not requiring muscle relaxation, during the study period extended over 12 months. Methods: After premedication with lorazepam (2 mg) the day before and hydroxyzine (100 mg) one hour before surgery, anaesthesia was induced with remifentanil administered continuously with a syringe pump at a rate of 1.20 +/- 0.06 mu g.kg(-1).min(-1) and propofol (3 mg.kg(-1) IV bolus). The trachea was intubated two minutes later and mouth opening, glottis exposure, glottis opening, movements, additional anaesthetic agents and chest rigidity were recorded. Results: Intubation conditions were excellent in 87% of patients, and the tube was inserted rapidly, within two minutes. However in 38% of patients the cuff inflation caused cough. In 13%, glottis opening was delayed and intubation required three minutes. A major decrease of arterial pressure and heart rate was recorded in 9 and 6% of patients respectively. Conclusion: Induction of anaesthesia using remifentanil and propofol allows satisfactory tracheal intubation without a muscle relaxant. However this technique is contraindicated: a) in patients with a full stomach, as intubation is not always successful at the first attempt; b) in patients scheduled to undergo neurosurgery or ophthalmic surgery, as tracheal intubation may elicit cough, increasing intracranial and intra-ocular pressure; c) in patients in poor circulatory status, as it decreases significantly arterial pressure and heart rate. (C) 1999 Elsevier, Paris.