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Remifentanil and propofol without muscle relaxants or with different doses of rocuronium for tracheal intubation in outpatient anaesthesia
Author(s) -
Schlaich N.,
Mertzlufft F.,
Soltész S.,
FuchsBuder T.
Publication year - 2000
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1034/j.1399-6576.2000.440610.x
Subject(s) - rocuronium , medicine , propofol , remifentanil , anesthesia , rocuronium bromide , neostigmine , tracheal intubation , muscle relaxant , muscle relaxation , intubation , atropine , sugammadex
Background: The use of muscle relaxants in outpatient anaesthesia is controversial; some authors recommend an induction regimen including propofol and opioids without muscle relaxants. This study evaluated the requirements for rocuronium after remifentanil/propofol. Methods: We examined in four groups of ASA I–II patients (n=30 for each) the intubating conditions three minutes after induction of anaesthesia with remifentanil 0.5 μg kg −1 min −1 , propofol 2 mg kg −1 without muscle relaxants or with different doses of rocuronium (0.6 mg kg −1 , 0.45 mg kg −1 , 0.3 mg kg −1 ) applying the criteria proposed by the Copenhagen Consensus Conference. In the second part of the study the time course of neuromuscular block was determined by electromyography using train‐of‐four (TOF) stimulation. To this end, another 60 ASA I–II patients were randomly assigned to receive remifentanil 0.5 μg kg −1 min −1 , propofol 2 mg kg −1 and either rocuronium 0.6 mg kg −1 , 0.45 mg kg −1 , 0.3 mg kg −1 , or 0.3 mg kg −1 followed by neostigmine 40 μg kg −1 and atropine 20 μg kg −1 at a T1 recovery of 10% (n=15 for each). Results: Intubating conditions were good or excellent in 30 patients after rocuronium 0.6 mg kg −1 and in 18 patients when rocuronium was omitted ( P <0.01). After 0.45 mg kg −1 and 0.3 mg kg −1 rocuronium the numbers were 29 and 30 patients, respectively. Reducing rocuronium from 0.6 mg kg −1 to 0.45 mg kg −1 or 0.3 mg kg −1 increased the onset time from 136 (35) s to 199 (34) s and 249 (52) s (mean (SD)), ( P <0.01); the clinical duration decreased from 38 (10) min to 24 (8) min and 16 (5) min, respectively ( P <0.01); and the duration to a TOF‐ratio of 0.8 decreased from 60 (11) min to 45 (9) min and 34 (7) min ( P <0.01). After rocuronium 0.3 mg kg −1 this time interval further decreased to 22 (3) min when neostigmine was given at a T1 of 10% ( P <0.01 compared with spontaneous recovery after rocuronium 0.3 mg kg −1 ). Conclusion: After remifentanil/propofol intubation conditions were poor in 40% of patients without muscle relaxants; adding reduced doses of rocuronium to this regimen improved the intubation conditions significantly. In addition, reducing the initial dose of rocuronium markedly shortened its time course of action.