European Society of Anaesthesiologists; 8th Annual Meeting with the Austrian International Congress; Vienna, Austria, 1-4 April 2000
Background and goal of study: The aim of this study was to evaluate the role of remifentanil in nasotracheal intubation for day case dental extraction. We compared remifentanil and alfentanil in terms of intubating conditions, time to return of spontaneous respiration, haemodynamic stability and post-op course.
Subjects and methods: The study received Ethics Committee approval and all patients gave written, informed consent. Using a double-blind design, 60 ASA grade I or II patients undergoing wisdom teeth extraction, were randomized to receive either remifentanil 1 μg kg−1 (group R), alfentanil 10 μg kg−1 (group A10) or alfentanil 20 μg kg−1 (group A20). Induction was with propofol 2.5 mg kg−1 and patients were intubated using either a blind nasal technique or direct laryngoscopy if the nasotracheal tube could not be placed blindly after three attempts. Anaesthesia was maintained using manual ventilation of the lungs with 1% isoflurane, 70% nitrous oxide and 30% oxygen. Haemodynamic data and time to return of spontaneous respiration (TRR) were recorded. Conditions for intubation were graded as: (1) excellent (blind nasal or jaw relaxed, cords abducted, no movement on passage of the tube), (2) good (cords abducted, jaw relaxed, some movement on intubation), (3) poor (cords abducted, difficulty opening mouth or movement on intubation) or (4) additional muscle relaxant needed for intubation. Follow up data was also recorded 2 h and 24 h postoperatively.
Results and discussion: Good or excellent intubating conditions were achieved in 43% of group R compared with 42% of group A10 and 42% of group A20. Significant differences in the TRR were seen between the three groups (P = 0.02), being fastest (4.8 min) in group R. TRR was 5.1 min in group A10 and 7.9 min in group A20. There was no significant difference in postoperative pain, nausea, vomiting or sore throat between groups.
Conclusion: Remifentanil affords similar intubating conditions in this setting to alfentanil and a more rapid and consistent time to return of spontaneous respiration. The frequency of successful intubation for both these drugs in lower than that reported for succinylcholine .
Acknowledgment including financial support: We thank Glaxo Wellcome for their support.
1 Alcock R, Peachey T, Lynch M et al. Comparison of alfentanil with succinylcholine in facilitating nasotracheal intubation in day-case anaesthesia. Br J Anaesth
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