Authors

BIJAN YAZDI1, MOHAMMAD KHALILI2, NILOUFAR DADASHPOUR3, SEYED MASOUD MOUSAVI NASAB4, MOHAMMAD KHABIRI5, MAJID GOLESTANI ERAGHI*6

Departments

1 Assistant Professor, Department of Anesthesiology, Arak University of Medical Sciences, Arak, Iran - 2 Assistant Professor, Department of Anesthesiology, Arak University of Medical Sciences, Arak, Iran - 3 Department of Anesthesiology, Arak University of Medical Sciences, Arak, Iran - 4 Department of Anesthesiology, Shahid Moddares Hospital, shahid beheshti University of Medical Sciences, Tehran, Iran - 5 Department of Anesthesiology, Shohada Tajrish Hospital, shahid beheshti University of Medical Sciences, Tehran, Iran - 6 Fellowship of criticalcare, Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran

Abstract

Background: Remifentanil is one of the most using adjuvant drug in rapid sequence intubation (RSI) because of its ultrashort action but there is no evidence to compare its effect with muscle relaxant. The aim of present was to assess and compare the effect of Remifentanil with Atracurium as a muscle relaxant in intubation condition.

Material and methods: In this double-blinded clinical trial 66 patients scheduled for elective surgery with general anesthesia and tracheal intubation were selected and receivedpropofol 2.5 mg/kg IV and Atropine 0.5 mg IV, thenrandomlydivided into two groups; group A received Atracurium 0.5 mg/kg and group R received Remifentanil 2 µg/kg intravenously. Intubation conditionusing criteria based on jaw relaxation, vocal cord movement and bucking on tracheal tube recorded 90 and 180 second after remifentanil and Atracurium administration respectively, and compared between groups.

Results: The mean age of participants was 31.55 ± 13.213 years, and 46 (69.7%) were men. Tracheal intubation of all patients were successful in first attempt. In Remifentanil group jaw joint was not fully relaxed in 3 patients. Moving vocal cords were seen in 6 and 3 patients of Remifentanil and Atracurium group respectively and closed vocal cords in 2 patients in Remifentanil group. There was no significant difference between intubating conditions and response to intubation variables between study groups (p=NS). The result of intubation was significantly better in Atracurium group (p=0.023).

Conclusion: According to the result of present study Remifentanil without muscle relaxant can make acceptable intubation condition. More studies to find optimal dose of remifentanil in RSI are needed.

Keywords

Atracurium, Intratracheal Intubation, Neuromuscular Blocking Agents, Propofol, Remifentanil.