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Propofol is superior to thiopental for intubation without muscle relaxants

  • Samar Taha
  • Sahar Siddik-Sayyid
  • Mahmoud Alameddine
  • Christiane Wakim
  • Chadi Dahabra
  • Adib Moussa
  • Mohammed Khatib
  • Anis Baraka
General Anesthesia
Accepted:

Abstract

Purpose

To compare intubating conditions and cardiovascular changes following induction of anesthesia and tracheal intubation in patients receiving either lidocaine-remifentanil-propofol or lidocaine-remifentanil-thiopental prior to induction.

Methods

In a randomized, double-blind study 76 healthy adult patients were assigned to one of two groups: lidocaine 1.5 mg kg-1, remifentanil 2μg kg-1 and propofol 2 mg kg-1 (Group P) or lidocaine 1.5 mg kg-1, remifentanil 2μg kg-1 and thiopental 5 mg kg-1 (Group T). Ninety seconds after the administration of the hypnotic agent, laryngoscopy and tracheal intubation were attempted. Intubating conditions were assessed as excellent, good or poor on the basis of ease of ventilation, jaw relaxation, position of the vocal cords, and patient’s response to intubation and slow inflation of the tracheal cuff. The mean arterial pressure (MAP) and heart rate (HR) were measured 45 sec after hypnotic agent administration, immediately after tracheal intubation, two and five minutes after intubation.

Results

Excellent intubating conditions were obtained in 84% of Group P patients and 50% of Group T patients (P < 0.05). The percentage decrease from baseline MAP was significantly higher in Group P than in Group T postinduction (27.4% ± 1 1.6 vs 21.8% ± 10.0) and immediately postintubation (19.0% ± 16.7 vs 11.2% ± 14.9). The percentage change from baseline HR was significantly higher in Group Pthan in Group T postinduction (13.8% ± 9.7 vs 0.5% ± 12.4), immediately postintubation (8.7% ± 13.7 vs 2.1% ± 13.1), and two minutes postintubation (7.04% ± 14.3 vs 3.5% ± 14.3).

Conclusion

Lidocaine-remifentanil-propofol is superior to lidocaine-remifentanil-thiopental for tracheal intubation without muscle relaxants. However, it induces more hypotension and bradycardia.

Keywords

Lidocaine Mean Arterial Pressure Tracheal Intubation Remifentanil Thiopental 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Le propofol est supérieur au thiopental pour l’intubation sans myorelaxants

Résumé

Objectif

Comparer les conditions d’intubation et les changements cardiovasculaires suivant l’induction de l’anesthésie et l’intubation endotrachéale chez les patients qui reçoivent un mélange de lidocaïne-rémifentanil-propofol ou de lidocaïne-rémifentanil-thiopental avant l’induction.

Méthode

Lors d’une étude randomisée et en double aveugle, 76 adultes sains répartis en deux groupes ont reçu : 1,5 mg kg-1 de lidocaïne, 2 μg kg-1 de rémifentanil et 2 mg kg-1 de propofol (Groupe P) ou 1,5 mg kg-1 de lidocaïne, 2 μg kg-1 de rémifentanil et 5 mg kg-1 de thiopental (Groupe T). La laryngoscopie et l’intubation endotrachéale ont été tentées 90 s après l’administration de l’agent hypnotique. Les conditions d’intubation ont été évaluées comme excellentes, bonnes ou pauvres fondées sur la facilité à ventiler, le relâchement de la mâchoire, la position des cordes vocales et la réaction du patient à l’intubation et au gonflement lent du ballonnet trachéal. La tension artérielle moyenne (TAM) et la fréquence cardiaque (FC) ont été mesurées 45 s après l’administration de l’agent hypnotique, immédiatement après l’intubation endotrachéale, deux et cinq minutes après l’intubation.

Résultats

Des conditions d’intubation excellentes ont été obtenues chez 84 % des patients du Groupe P et 50 % du Groupe T (P < 0,05). La TAM a été significativement réduite par rapport aux mesures de base, davantage dans le Groupe P que dans le Groupe T après l’induction (27,4 % ± 11,6vs21, 8% ± 10,0) et immédiatement après l’intubation (19,0 % ± 16,7 vs 11,2% ± 14,9). La FC a été modifiée par rapport aux mesures de base, plus dans le Groupe P que dans le Groupe T après l’induction (13,8 % ± 9,7 vs 0,5 % ± 12,4), immédiatement après l’intubation (8,7 % ± 13,7 vs 2,1 % ± 13,1) et deux minutes après l’intubation (7,04% ± 14,3 vs 3,5% ± 14,3).

Conclusion

Le mélange de lidocaïne-rémifentanil-propofol est supérieur à celui de lidocaïne-rémifentanil-thiopental pour l’intubation endotrachéale sans myorelaxants. Cependant, il induit plus d’hypotension et de bradycardie.

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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Samar Taha
    • 1
  • Sahar Siddik-Sayyid
    • 1
  • Mahmoud Alameddine
    • 1
  • Christiane Wakim
    • 1
  • Chadi Dahabra
    • 1
  • Adib Moussa
    • 1
  • Mohammed Khatib
    • 1
  • Anis Baraka
    • 1
  1. 1.Department of AnesthesiologyAmerican University of Beirut Medical CenterBeirut, Beirut, Lebanon

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