Using Diferent Doses Of Remifentanil And Propofol In Endotracheal Intubation Without Muscle Relaxants:A Comparative Study

Objectives:Comparing the vital signs and intubation conditions when using three different doses of remifentanil and propofol in endotracheal intubation without muscle relaxants under Glidescope,our research aims to study the feasibility of using different doses of remifentanil and propofol in endotracheal intubation without muscle relaxants under Glidescope,and the suitable compatibility of medicines of the remifentanil and propofol.Methods:There were a total of 94 patients who were undergoing elective surgeries of thyroidectomy with the intraoperative nerve monitoring under general anesthesia in our hospital,the preoperative airway evaluation Mallampati class?^?and American Society of Anesthesiologists physical status?^?,aged 20⁶5 years old,BMI18.5²7 kg/m² were included.The patients were divided into the following three groups by random number lottery:Group A,31 patients were received with 2mg/kg propofol induced by 3.0?g/kg remifentanil during anesthesia induction;Group B,30 patients were induced by2mg/kg propofol combined with 3.5?g/kg remifentanil during anesthesia induction;Group C,33 patients were induced by 2mg/kg propofol combined with 4.0?g/kg remifentanil during anesthesia induction.The heart rate?HR?,oxygen saturation?SpO₂?,mean arterial pressure?MAP?and brain electrical double frequency index?BIS?of all the patients during T0?after attending the operating room,before anesthesia induction?,T1?the time when consciousness disappeared?,T2?before the endotracheal intubation?,T3?1 minute after the endotracheal intubation?,T4?3 minutes after the endotracheal intubation?were observed and recorded.The tracheal intubation conditions of the patients and their scores were recorded.Possible adverse reactions with the intubation,such as loss of tooth,oral and pharyngeal injuries were recorded.Results:?1?There was no statistically significant difference between the three groups in gender ratio,height,weight,age,BMI and mallampatty grade in preoperative airway assessment?P>0.05?.?2?All the three groups showed a significant decrease in HR after induction compared with T0?P<0.05?.Compared with group C,HR in group B was higher at T1 and T2?P<0.05?.Compared with group C,HR in group A was higher at T3?P<0.05?.All the SpO₂ values in the three groups were higher than T0 after the endotracheal intubation?P<0.05?,and the SpO₂ values in group A and group B were higher than those in group C?P<0.05?.MAP of the three groups showed a significant decrease compared with T0 after the induction of the anesthesia?P<0.05?.The MAP of group A was higher than that of group B and C at T2?P<0.05?.Patients in all the three groups showed a significant drop in blood pressure?the drop value of blood pressure was more than 20%of the basic blood pressure?,and there were fewer patients in group A and group B who had a significant drop in blood pressure than the patients in group C?P<0.05?.BIS values in all three groups decreased after induction compared with T0?P<0.05?.BIS values in group A were lower than that in group B and group C at baseline T0?P<0.05?,BIS values in group A at time T1 were higher than that in group C?P<0.05?,and BIS values in group A at time T3 were higher than that in group B?P<0.05?.At T1,BIS values in group B were higher than that in group C?P<0.05?.?3?The glottis opening degree of group B and group C was better than that of group A?P<0.05?,and the cough response degree and the response of the body movement were also less than that in group A?P<0.05?.The degree of the inflatable reaction in group C was less than that in group A?P<0.05?.The intubation satisfaction of group B and C was better than that of group A?P<0.05?.The success rate of intubation in group B and C was higher than that in group A?P<0.05?.Considering both the hemodynamics and the intubation conditions,although the hemodynamics of group A was relatively stable,the intubation conditions were worse than those in group B and C.Although there was no significant difference in intubation conditions between group C and group B,hemodynamics was better in group B.The hemodynamics of group B was relatively stable,and group B could provide appropriate intubation conditions,it was a suitable plan for the endotracheal intubation without muscle relaxant under the Glidegoscope.Conclusion:A combination of 2mg/kg propofol with 3.5?g/kg remifentanil for anesthesia induction,can provide appropriate intubation conditions and hemodynamic stability,is suitable for the tracheal intubation under Glidescope without muscle relaxants.