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PubMedDate not supplied

Rapid oral anesthesia for awake intubation.

STUDY OBJECTIVE: To determine whether sodium benzonatate (Tessalon Perles) can provide rapid, effective topical oral anesthesia in preparation for awake intubations. DESIGN: Randomized, controlled, single-blind study. SETTING: Medical center anesthesia department. PATIENTS: Forty patients counseled for an awake intubation. INTERVENTIONS: The patients were randomized (random permutated block) to receive either benzonatate 200 mg topically for oropharyngeal anesthesia or bilateral superior laryngeal nerve blocks (total 8 ml of 1% lidocaine) in conjunction with 2 ml of 20% benzocaine orally. Both groups were administered 4 ml of 4% lidocaine translaryngeally. If nasal intubation was anticipated, the patients received 6 ml of 2% lidocaine jelly for nasal anesthesia. MEASUREMENTS AND MAIN RESULTS: The time to obtain oropharyngeal anesthesia was measured as the time from obtaining the benzonatate capsules from the bottle or palpation of the neck to locate the hyoid bone to the time when the patient exhibited an absent gag response to an oropharyngeal airway. After completion of airway preparation, the patient's response to intubation was evaluated by an anesthesiologist blinded to the method of preparation. Medications administered for sedation and analgesia were recorded. Noninvasive blood pressure, heart rate (HR), cardiac rhythm, and three-lead ST segments (I, II, V5) were recorded and evaluated for changes from baseline. Postoperatively, the patient was questioned for recall of the intubation. The time required to obtain loss of the gag response was shorter in the benzonatate group (55.1 +/- 5.7 seconds vs 339 +/- 22.4 seconds, p less than 0.005). The patient response to intubation was similar in both groups (90% no response, 10% minimal response). No abnormal cardiac rhythms or ST segment depression occurred, and mean arterial pressure and HR did not increase more than 20%. CONCLUSIONS: The results of this study indicate that benzonatate capsules provide rapid and reliable oropharyngeal anesthesia in preparation for awake intubation. In addition, if excellent airway anesthesia is provided, awake intubations can be accomplished with minimal patient response and discomfort.

Administration, Oral↗
PubMed1995

Hemodynamic comparison of direct vision versus blind oral endotracheal intubation.

STUDY OBJECTIVE: To determine the hemodynamic response to airway manipulation and endotracheal intubation by comparing the direct oral method of the Macintosh laryngoscope to the blind oral method of the Augustine guide. DESIGN: Prospective, comparative, randomized study. SETTING: University medical center. PATIENTS: 24 ASA physical status I and II, nonpregnant female patients aged 18 years or older, undergoing outpatient gynecologic surgery with general anesthesia. INTERVENTIONS: Patients were preoxygenated and received alfentanil 10 mcg/kg five minutes prior to anesthesia induction with thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg. Under random assignment, patients (n = 12 in each group) were intubated with the Macintosh laryngoscope or the Augustine guide. After intubation, 50% nitrous oxide and 50% oxygen and 1.5% inspired concentration of isoflurane were administered. MEASUREMENTS AND MAIN RESULTS: Oxygen saturation, heart rate (HR), and mean arterial pressure (MAP) were measured at baseline and at minutes 1 to 6 postinduction (time zero). Intubation time was defined as the interval between removal of the face mask from the patient's face and reconnection of the circle system airway connector after successful endotracheal intubation. The number of attempts and time to successful endotracheal intubation were noted. There was no difference between groups in age, weight, height, Mallampati airway class, oxygen saturation (at least 98%), or MAP. There was a significant difference (p < 0.01) between groups (percent change from baseline) in HR from minutes 1 to 4 postinduction. Time to successful endotracheal intubation was significantly longer (p < 0.05, mean +/- SEM) with the Augustine guide (91.0 +/- 15.9 seconds) than with the Macintosh laryngoscope (24.0 +/- 1.73 seconds). CONCLUSIONS: The Augustine guide, a new technique for orally intubating patients blindly and when head and neck manipulations are contraindicated, had less of an effect on HR compared with the Macintosh laryngoscope. Minimal lifting of the tongue and mandible required with the Augustine guide could account for the decreased HR response. The Augustine guide appears to be a promising new addition to the airway armamentarium and deserves further testing.

Adolescent↗
PubMed2005

Use of gum elastic bougie for prehospital difficult intubation.

The objective of this study was to assess effectiveness of gum elastic bougie (GEB) in case of difficult intubation occurring in the prehospital settings. After manikin training to GEB handling, physicians were recommended to use GEB as first alternative technique in case of difficult intubation. Intubating conditions and details of patients requiring GEB-assisted laryngoscopy were recorded over 30 months. Among the 1442 extrahospital intubations performed, 41 patients (3%) required GEB. Gum elastic bougie allowed successful intubation in 33 cases (78%) and 8 patients sustained a second alternative technique. One patient was never intubated, another 1 required rescue cricothyroidotomy. Twenty-four (60%) GEB patients had associated factors for difficult intubation such as reduced or limited cervical spine mobility, morbid obesity, cervicofacial trauma, and ears, nose, and throat neoplasia. The success rate of GEB was 75% and 94%, respectively, depending on whether associated factors for difficult intubation are present or not. No adverse events associated to GEB use were noted.

Airway Obstruction↗
PubMed2005

The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system.

STUDY OBJECTIVE: We evaluate the association between out-of-hospital use of continuous end-tidal carbon dioxide (ETCO2) monitoring and unrecognized misplaced intubations within a regional emergency medical services (EMS) system. METHODS: This was a prospective, observational study, conducted during a 10-month period, on all patients arriving at a regional Level I trauma center emergency department who underwent out-of-hospital endotracheal intubation. The regional EMS system that serves the trauma service area is composed of multiple countywide systems containing numerous EMS agencies. Some of the EMS agencies had independently implemented continuous ETCO2 monitoring before the start of the study. The main outcome measure was the unrecognized misplaced intubation rate with and without use of continuous ETCO2 monitoring. RESULTS: Two hundred forty-eight patients received out-of-hospital airway management, of whom 153 received intubation. Of the 153 patients, 93 (61%) had continuous ETCO2 monitoring, and 60 (39%) did not. Forty-nine (32%) were medical patients, 104 (68%) were trauma patients, and 51 (33%) were in cardiac arrest. The overall incidence of unrecognized misplaced intubations was 9%. The rate of unrecognized misplaced intubations in the group for whom continuous ETCO2 monitoring was used was zero, and the rate in the group for whom continuous ETCO2 monitoring was not used was 23.3% (95% confidence interval 13.4% to 36.0%). CONCLUSION: No unrecognized misplaced intubations were found in patients for whom paramedics used continuous ETCO2 monitoring. Failure to use continuous ETCO2 monitoring was associated with a 23% unrecognized misplaced intubation rate.

Adolescent↗
PubMed2004

Nasolacrimal duct obstruction in children: outcome of intubation.

BACKGROUND: Nasolacrimal silicone intubation is a treatment for congenital nasolacrimal duct obstruction (NLDO) after failed probing and irrigation. Functional outcome has been previously reported as poorer in children with Down syndrome. METHOD: The outcome of 122 cases of silicone bicanalicular nasolacrimal intubation, performed between 1988 and 2002 on 97 children aged 11 months to 9.5 years, was retrospectively reviewed. In all children, intubation was performed under direct vision using nasal endoscopy. Statistical analysis, including multiple logistic regression analysis, was used to assess the effects of duration of intubation, and age at surgery, on treatment outcome, and to determine potential predictors of treatment failure. RESULTS: The overall success rate was 85%, with 89% success for eyes in children with Down syndrome and 85% success for eyes in children without Down syndrome. Success rates were consistently high (83% to 100%) for children who underwent surgery between 1 and 4 years of age. The average duration of intubation was 5.5 months. Increasing duration of intubation was not associated with increasing chance of success, but with a significantly higher risk of failure if greater than 18 months (P = 0.03). Retention of stents for longer than 12 months was associated with a significantly lower success rate (67%). The presence of Down syndrome, increasing age at surgery, or gender were not predictive factors for treatment failure. Unplanned removal of tubes because of dislodgement was the most common complication, occurring in 25% of eyes, but did not affect functional outcome. CONCLUSIONS: Nasolacrimal silicone intubation, under direct nasal endoscopic visualization, is a consistently successful procedure for the treatment of NLDO among children aged older than 12 months of age. Tubing should be left in place for a maximum of 12 months because the success rate declines after this period and the risk of failure is significantly increased after 18 months of intubation. Prematurely dislodged tubes need not be replaced unless symptoms of nasolacrimal obstruction occur, because this does not lead to an increased risk of treatment failure.

Child↗
PubMed2006

A clinical assessment of the Glidescope videolaryngoscope in nasotracheal intubation with general anesthesia.

STUDY OBJECTIVES: To evaluate the efficacy and safety of the Glidescope videolaryngoscope as a device to aid nasotracheal intubation, and to determine whether the GSVL provides a better laryngeal view in patients with difficult laryngoscopy compared with the Macintosh laryngoscope. DESIGN: Prospective, clinical study. SETTING: Two university hospitals. PATIENTS: 156 healthy adult ASA physical status I and II undergoing elective plastic and intraoral surgery with general anesthesia. INTERVENTIONS: After anesthesia induction with intravenous injection of fentanyl 2 microg/kg, propofol 2 mg/kg, and vecuronium 0.1 mg/kg, nasotracheal intubation was performed using GSVL. MEASUREMENTS: Preoperative airway measurements were taken to predict potential difficult airways. During nasotracheal intubation using GSVL, laryngeal views, times required for full visualization of glottis and successful intubation, difficulty encountered and auxiliary maneuvers adopted, and upper airway trauma were recorded. The laryngeal views obtained by GSVL and by Macintosh laryngoscope were compared. MAIN RESULTS: The laryngeal views obtained by GSVL in all patients were Cormack and Lehane (C&L) grades I and II, and the success rate of intubation using GSVL at one attempt was 98.1%. The times required for visualization of the glottis and successful intubation were 40.2 +/- 11.5 s and 52.7 +/- 12.3 seconds, respectively. Patients with C&L grade II needed more auxiliary maneuvers to achieve successful intubation than did those with C&L grade I (P < 0.001). In 36 patients with potential difficult airways, the frequency of difficult laryngoscopy (C&L grades III and IV) with the Macintosh laryngoscope (58.3%) was significantly higher than with the GSVL (0%, P < 0.05). The frequency of minor upper airway trauma was 4.5%. CONCLUSIONS: The GSVL is an effective device for nasotracheal intubation and may be incorporated easily into routine clinical practice. Compared with the Macintosh laryngoscope, the GSVL can provide an improved laryngeal view in the patient with difficult airway.

Adolescent↗
PubMed2004

Duration of intubation attempts during neonatal resuscitation.

OBJECTIVE: Since the American Academy of Pediatrics Neonatal Resuscitation Program recommends that intubation should be completed in approximately 20 seconds, we measured the duration of neonatal intubation attempts by different operators, using video recordings of neonatal resuscitations. STUDY DESIGN: We used an ongoing quality improvement program to measure the duration of intubation attempts. RESULTS: The mean duration for the 50 successful intubations, including 6 for meconium, was 27.3 seconds compared with 29.8 seconds for unsuccessful attempts (not significant). Fifteen infants were successfully intubated on each of the first and second attempts, 10 on the third attempt, and 10 required more than 3 attempts. The mean duration of successful intubation was 31.9 seconds for PL-1's, 27.5 seconds for PL-2/3's, and 23.6 seconds for fellows. Overall intubations were more successful for a duration of 30 seconds or less compared with 20 seconds or less (72% vs 38%; chi(2)=10.3, P=.001). No infant decompensated between 20 and 30 seconds. Ten successful and 12 failed attempts took longer than 40 seconds. CONCLUSIONS: We recommend that a duration of 30 seconds is a reasonable guideline for neonatal intubation during resuscitation.

Clinical Competence↗
PubMedDate not supplied

A comparison of patients' communication-related responses during intubation and after extubation.

OBJECTIVE: The purpose of this exploratory pilot study was to examine patients' communication-related responses during intubation and after extubation, and to determine whether differences in patients' report of responses at these two points in time, if present, were associated with demographic and situational variables. DESIGN: Descriptive comparative. SETTING: Four intensive care units in a midwestern, university-affiliated medical center. PATIENTS: Convenience sample of 29 patients intubated for 24 or more hours, alert and oriented to person, place, and setting during intubation and after extubation. OUTCOME MEASURES: Emotional responses (anger and worry/fear) to being unable to speak, perceived difficulty with communication. RESULTS: Paired t tests showed no significant differences over time in the mean scores of the Emotion subscales and Ease of Communication scale. However, more than 30% of subjects reported postextubation responses that were different from their earlier responses by 20% or more. Significant differences in subjects' worry/fear at being unable to speak and difficulty with communication were found in relation to history of prior intubation and total number of days intubated. Subjects varied in the number of days that they were intubated, and the number of days intubated when they first participated in the study. CONCLUSIONS: Results provide direction for larger longitudinal prospective and retrospective studies with larger samples that examine patients' recall of their responses during intubation, especially related to communication.

Adult↗
PubMed1993

Does nasotracheal intubation increase complications in patients with skull base fractures?

STUDY OBJECTIVES: To determine if the complications associated with skull base fractures are increased when nasotracheal intubation is performed in the field. DESIGN: Retrospective, case-control study over a five-year period. SETTING: A helicopter service returning to a Level I trauma center. TYPE OF PARTICIPANTS: All injured patients treated in the field who had either radiographic or clinical evidence of skull base fractures in whom nasotracheal intubation was attempted (38) compared with all patients with skull base fractures in whom nasotracheal intubation was not attempted (48) and a convenience sample of patients without skull base fractures in whom nasotracheal intubation was attempted (45). Patients with obvious midface motion on initial examination were excluded. Complications of skull base fractures were categorized as cerebral spinal fluid leak of longer than 24 hours and/or meningitis, cranial nerve injury, diabetes insipidus, and intracranial placement of the endotracheal tube. INTERVENTIONS: Blind nasotracheal intubation was performed by experienced flight nurses. RESULTS: There were no patients in whom an endotracheal tube was placed intracranially. There was no significant difference in complication rate between the two groups with skull base fractures (with nasotracheal intubation, 24%; 95% confidence interval, 11% to 40%; without nasotracheal intubation, 25%; 95% confidence interval, 14% to 40%). The group without skull base fracture had none of the complications usually associated with skull base fractures. CONCLUSION: Patients with skull base fracture have a significant complication rate (25%). The complications associated with skull base fractures are not markedly increased by attempts at nasotracheal intubation in the field.

Adult↗
PubMed1992

Rapid-sequence intubation of head trauma patients: prevention of fasciculations with pancuronium versus minidose succinylcholine.

INTRODUCTION: Fasciculations during rapid-sequence intubation may lead to increased intracranial pressure and emesis with aspiration. Standard rapid-sequence intubation requires a nondepolarizing blocking agent before succinylcholine administration. HYPOTHESIS: Prevention of fasciculations during rapid-sequence intubation of head trauma patients can be accomplished as safely and effectively with minidose succinylcholine as with a defasciculating dose of pancuronium. DESIGN: A prospective, randomized, double-blind study. SETTING: An inner-city county trauma center with 70,000 patient visits per year. PARTICIPANTS: Sequential adult head trauma patients requiring rapid-sequence intubation who had no contraindications to succinylcholine or pancuronium. INTERVENTIONS: Each head trauma patient requiring rapid-sequence intubation who met the inclusion criteria received standard rapid-sequence intubation maneuvers and lidocaine (1 mg/kg) IV. Patients were randomized to receive either minidose succinylcholine (0.1 mg/kg) or pancuronium (0.03 mg/kg) IV one minute prior to the full paralytic dose of succinylcholine (1.5 mg/kg) IV. Fasciculations were recorded using a graded visual scale. RESULTS: Of 46 patients, eight of 19 (42%) in the pancuronium group and six of 27 (22%) in the succinylcholine group experienced fasciculations. No statistically significant difference in fasciculations was detected between the two groups using chi 2 analysis. Complete relaxation of the cords was present in all but two patients, one in each group. No patient in either group experienced emesis or significant dysrhythmias. CONCLUSION: Pretreatment with minidose succinylcholine causes no greater incidence of fasciculations than pancuronium in rapid-sequence intubation of head trauma patients in an ED setting. Thus succinylcholine may be used as the sole paralytic agent in rapid-sequence intubation of head trauma patients.

Adult↗
PubMed1994

Emergency intubation of the pediatric medical patient: use of anesthetic agents in the emergency department.

STUDY OBJECTIVES: To delineate the diagnoses of children who required emergency intubation, to ascertain which medications were used, and to describe the complications of intubation and their association with the choice of medications. DESIGN, SETTING, AND TYPE OF PARTICIPANTS: Three-year retrospective study of 60 intubations of critically ill pediatric patients by pediatric emergency physicians in the emergency department setting. MEASUREMENTS AND MAIN RESULTS: Clinical complications were noted for intubations with neuromuscular paralysis and intubations initially attempted without a paralyzing agent. Intubations attempted without neuromuscular paralysis resulted in a higher rate of complications (53% versus 26%) and a greater risk of more than one complication per intubation. This finding appeared to be independent of physicians' clinical experience. CONCLUSION: Rapid-sequence protocols with paralysis facilitate intubations in the complex pediatric patient in the ED setting.

Adolescent↗
PubMed1996

Prehospital endotracheal intubation of children by paramedics.

STUDY OBJECTIVE: To describe the experience of an emergency medical services system with the use of liberal indications for prehospital pediatric endotracheal intubation. METHODS: We performed a retrospective review of prehospital and hospital patient records in an urban and suburban prehospital care system. The study included all children aged 15 years or younger who were intubated in the prehospital setting by King County paramedics from January 1, 1984, to December 31, 1990. RESULTS: During the 7-year study period, 654 children were intubated, of which 355 (54%) were study patients. The median age of the patients was 3 years; 60% had an injury diagnosis. On arrival of the paramedics, 60% of the patients were in sinus rhythm, 62% had a systolic blood pressure of 70 mm Hg or greater, and 56% had a respiratory rate of 10 breaths per minute or greater. The Glasgow Coma Scale score was 8 or lower in 83% of the patients. Succinylcholine was used to facilitate intubation in 47% of patients. On arrival at the emergency department, 79% of the patients were in sinus rhythm; 75% had an adequate blood pressure (70 mm Hg or greater); 86% had a PaO2 value of 100 mm Hg or greater; and 74% had a PaCO2 value of 45 mm Hg or lower. Complications of intubation, more than half of which were classified as minor, were noted in 22.6% of patients. We were unable to determine the number of failed intubation attempts. Most of the patients (58%) survived to hospital discharge. Among cardiac arrest victims, only 12% survived. CONCLUSION: In a setting where paramedics practice with close medical direction, applying liberal indications for pediatric intubation and permitting the use of succinylcholine allowed paramedics to intubate children of different ages and diagnoses.

Adolescent↗
PubMed1998

Intubation success rates improve for an air medical program after implementing the use of neuromuscular blocking agents.

To determine whether the success rate for endotracheal intubation improves after implementing the use of neuromuscular blocking (NMB) agents in an air medical program, this retrospective study analyzed all patients requiring endotracheal intubation at two air medical programs (nurse/paramedic crews) over a 5-year period. Air medical program A, the control group, had employed NMB agents throughout the entire study period. Air medical program B, which did not use NMB agents from July 1, 1989 through June 30, 1992, implemented their use starting July 1, 1992. For program A, the overall intubation success rate was 93.5% (202 successful intubations in 216 patients) and the successful intubations/total attempts ratio was 0.67 (202 of 301). For program B, the overall intubation success rate improved from 66.7% (46 successful intubations in 69 patients) before NMB agent use to 90.5% (57 in 63) after NMB agent use (P = .001). The successful intubations/total attempts ratio increased from 0.36 (51 of 141) prior to NMB agent use to 0.48 (63 of 132) after NMB agent use (P = NS). In comparing the 92 patients who did not receive NMB agents to the 40 patients who did, the intubation success rate increased from 69.6% (64 of 92) to 97.5% (39 of 40) (P < .001) and the successful intubation/total attempts ratio increased from 0.36 (73 of 202) to 0.58 (41 of 71) (P = .007). With the use of NMB agents, program B's overall intubation success rate increased significantly, matching the results of program A.

Adjuvants, Anesthesia↗
PubMed1999

Complications of emergency intubation with and without paralysis.

Expert and definitive airway management is fundamental to the practice of emergency medicine. In critically ill patients, rapid sedation and paralysis, also known as rapid-sequence intubation, is used to facilitate endotracheal intubation in order to minimize aspiration, airway trauma, and other complications of airway management. An alternative method of emergent endotracheal intubation, intubation minus paralysis, is performed without the use of neuromuscular blocking agents. The present study compared complications of these two techniques in the emergency setting. Sixty-seven intubations minus paralysis were prospectively compared with 166 rapid-sequence intubations. Complications were greater in number and severity in the nonparalyzed group and included aspiration (15%), airway trauma (28%), and death (3%). None of these difficulties were observed in the rapid-sequence group (P < .0001). These results show that rapid-sequence intubation when compared with intubation minus paralysis significantly reduces complications of emergency airway management and should be made available to emergency physicians trained in its use.

Adult↗
PubMedDate not supplied

Nasotracheal intubation in the emergency department, revisited.

This retrospective study was designed to investigate the current practice of nasotracheal intubation (NTI) in the Emergency Department (ED) at the University of California, San Diego Medical Center. Over a 5-year period, 21% (105/501) of patients intubated in the ED had at least one NTI attempt. The most frequent primary diagnoses in these patients included drug overdose, congestive heart failure, and chronic obstructive pulmonary disease. We report an overall NTI success rate of 79% (83/105). Sixty-one percent (64/105) of the patients were nasally intubated on the first NTI attempt. Nasal dilators, topical neosynephrine, and sedation improved NTI success rates. Epistaxis and improper tube position were the most common immediate complications. Sinusitis, pneumonia, and sepsis were the most frequent late complications. Patients receiving thrombolytic therapy were at risk of developing severe epistaxis. A prior history of sinus disease may predispose a nasally intubated patient to sinusitis. The complication rates reported here are similar to those of previous studies. A survey of emergency medicine (EM) residency programs found that EM residents throughout the country perform an average of 2.8 NTIs during their residency training. Thus, there is limited exposure to this intubation technique in EM residency programs. Nasotracheal intubation is a useful alternative to oral intubation, particularly when oral access is compromised. While not the optimal approach, we conclude that NTI is still a valuable method for establishing an airway and should remain among the emergency physician's arsenal of intubation techniques.

Adolescent↗
PubMed2002

Tracheal intubation conditions and cardiovascular effects after modified rapid-sequence induction with sevoflurane-rapacuronium versus propofol-rapacuronium.

STUDY OBJECTIVES: To compare intubation conditions and hemodynamic effects resulting from rapid-sequence induction of anesthesia with sevoflurane-rapacuronium and propofol-rapacuronium. DESIGN: Randomized, blinded study. SETTING: Operating suites of a large university-affiliated medical center. PATIENTS: 40 ASA physical status I and II adult patients without airway abnormalities who were scheduled for elective surgery requiring endotracheal intubation. INTERVENTIONS: Patients were randomly allocated to receive either sevoflurane inhalational induction (Group 1) or propofol (2 mg/kg) intravenous induction (Group 2). Group 1 patients were coached on how to perform vital capacity breathing and the anesthesia machine was primed with sevoflurane 8%, N2O:O2 3.5:1.5 L/min. In both groups, when loss of consciousness was established, rapacuronium 1.5 mg/kg was administered. After 50 seconds, an anesthesiologist blinded to the study entered the room and attempted laryngoscopy and intubation. MEASUREMENTS: Intubation conditions were graded as excellent, good, poor, or impossible according to Good Clinical Research Practice (GCRP) criteria. Arterial blood pressure and heart rate changes accompanying both induction techniques were also monitored and recorded. MAIN RESULTS: All patients were successfully intubated within 60 seconds. Clinically acceptable intubating conditions (excellent or good scores) were obtained in 19 of 20 Group 1 patients and in 19 of 20 Group 2 patients. Moderate tachycardia was encountered in both groups and mild systolic hypotension in the Group 2 patients. There were no complications. CONCLUSIONS: Modified rapid-sequence inhalational induction using sevoflurane and rapacuronium produced clinically acceptable intubation conditions within 60 seconds of muscle relaxant administration. The intubation conditions were similar to those produced after intravenous propofol and rapacuronium.

Adolescent↗
PubMed2003

Does the choice of intravenous induction drug affect intubation conditions after a fast-onset neuromuscular blocker?

STUDY OBJECTIVES: To compare intubation conditions and hemodynamic effects resulting from thiopental-rapacuronium, propofol-rapacuronium, and etomidate-rapacuronium intravenous (IV) induction. DESIGN: Randomized, blinded study. SETTING: Operating suites of a large university-affiliated medical center. PATIENTS: 60 ASA physical status I and II adult patients without airway abnormalities, who were scheduled for elective surgery requiring endotracheal intubation. Patients were randomly allocated to receive IV thiopental sodium 5 mg/kg (Group 1), propofol 2 mg/kg (Group 2), or etomidate 0.3 mg/kg (Group 3) followed by rapacuronium 1.5 mg/kg. Fifty seconds later, an anesthesiologist, who had no knowledge of the induction drug used, entered the operating room and attempted laryngoscopy and intubation. MEASUREMENTS: Intubation conditions were graded as excellent, good, poor, or impossible according to Good Clinical Research Practice criteria. Arterial blood pressure and heart rate changes accompanying both induction techniques were also monitored and recorded. MAIN RESULTS: All patients were intubated within 55 to 70 seconds. Clinically acceptable intubation conditions were not statistically different among the three groups. Moderate tachycardia after induction was seen in all three groups, and blood pressure was significantly lower in Group 2 than in Groups 1 or 3. CONCLUSIONS: Clinically acceptable intubation conditions are similar after either thiopental, propofol, or etomidate when a fast-onset neuromuscular blocking drug (rapacuronium 1.5 mg/kg) is used to facilitate tracheal intubation.

Adult↗
PubMed1997

Double-blind comparison of two doses of rocuronium and succinylcholine for rapid-sequence intubation.

STUDY OBJECTIVE: To compare the pharmacodynamics of two commonly recommended doses of rocuronium bromide (0.7 mg/kg and 0.9 mg/kg) and succinylcholine (1.5 mg/kg) when used for rapid-sequence intubation. DESIGN: Prospective, double-blind, randomized study. SETTING: Operating rooms at a university hospital. PATIENTS: 45 ASA physical status I and II adult patients scheduled for elective surgeries under general anesthesia. INTERVENTIONS: Nonpremedicated patients were anesthetized with fentanyl 2 mcg/kg followed by thiopental sodium 4 to 5 mg/kg and muscle relaxant using rapid-sequence technique. Group 1 (n = 15) received rocuronium bromide 0.7 mg/kg. Group 2 (n = 16) received rocuronium bromide 0.9 mg/kg, and Group 3 (n = 14) received succinylcholine 1.5 mg/kg. Intubation was performed 60 seconds after the administration of muscle relaxant. MEASUREMENTS AND MAIN RESULTS: The case of intubation was scored using a scale of 1 to 4. Blood pressure and heart rate were measured beginning one minute before induction of anesthesia up to 5 minutes after intubation. Intubation scores were similar in groups 2 and 3 and were noted as good or excellent in all patients. Group 1 displayed a significantly lower intubation score than the other two groups; 60% were rated as poor. No significant differences in hemodynamic data were seen among the three groups. CONCLUSIONS: Rocuronium bromide at a dose of 0.9 mg/kg provides intubating conditions similar to succinylcholine 1.5 mg/kg at 1 minute. Intubating conditions at 1 minute following a 0.7 mg/kg dose of rocuronium are not as good as those following a 0.9 mg/kg dose of rocuronium or a 1.5 mg/kg dose of succinylcholine.

Adolescent↗