Efficacy Of Induction With Sevoflurane Combined With Remifentanil Or Sufentanil For Tracheal Intubation Without Muscle Relaxants

Objective To evaluate the efficacy of induction with sevoflurane combined with remifentanil or sufentanil for tracheal intubation without muscle relaxants.Methods Seventy-five ASAâ… orâ…¡patients, aged 20-60 yr, weighing 45-75 kg, were randomly divided into 3 groups (n=25 each): remifentanil group (group R) , sufentanil group (group S) and control group(group C). Anesthesia was induced with inhalation of 8% sevoflurane in 100% oxygen in group R and S. Sevoflurane was inhaled initially with high-flow oxygen(6L/min). Remifentanil 2.0 ug·kg^-1 in group R was injected slowly over 1 min when the patient's eyelash reflex disappeared, and sufentanil 0.4 ug·kg^-1 in group S was injected slowly over 1 min when sevoflurane was inhaled. 2 min after the patient's eyelash reflex disappeared sevoflurane inhalation was then stopped. The patients were mechanically ventilated after tracheal intubation. In group C, anesthesia was induced with propofol 2mg·kg^-1, rocuronium 1mg·kg^-1and fentanyl 3ug·kg^-1. MAP, HR, SpO₂ and BIS were recorded before administration, at the time of disappearance of eyelash reflex, immediately before and after tracheal intubation, and 1, 3 and 5min after tracheal intubation. The time period from sevoflurane inhalation to disappearance of eyelash reflex and to tracheal intubation were recorded. P_ETCO₂ and end-expiratory sevoflurane concentration were recorded. Intubating conditions were assessed using a four-point scoring system based on ease of laryngoscopy, jaw relaxation, position of vocal cords, degree of coughing and limb movement. Results All patients were successfully intubated at first attempt. The satisfactory intubation conditions were found in 88% in group R, 96% in group S and 100% in group C. The difference was not statistically significant (P>0. 05). Compared to the time of disappearance of eyelash reflex, the decrease in MAP and BIS were significant in all groups, and HR was lower in group R at each other time point, and decreased at 3, 5 min post-intubation in group S (P<0. 05). MAP, HR remained stable at the time before and after tracheal intubation in group S, and in group R and C MAP increased significantly at post-intubation compared to pre-intubation (P<0. 01). The incidence of hypotension and bradycardia in three groups there was no significant difference (P>0.05). BIS value was maintained at 40-60 before and after tracheal intubation.Conclusion 8% Sevoflurane combined with remifentanil or sufentanil provides acceptable tracheal intubating conditions and satisfactory hemodynamic stability, and can be used for tracheal intubation without muscle relaxants.