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Canadian Journal of Anaesthesia

, Volume 50, Issue 2, pp 121–126 | Cite as

Muscle relaxation and increasing doses of propofol improve intubating conditions

  • Thomas LieutaudEmail author
  • Valérie Billard
  • Huguette Khalaf
  • Bertrand Debaene
General Anesthesia

Abstract

Purpose

Muscle relaxants and anesthetics are usually associated during intubation. However, their relative role to facilitate the process is not dearly defined. This study was designed to determine, during intubation: i) the relative role of anesthetics and atracurium-induced neuromuscular block and; ii) the effect of different doses of propofol in the presence of complete muscle block.

Methods

Patients were randomized to four groups and received fentanyl and a standardized anesthetic procedure. Patients from groups high (H;n = 45), medium (M;n = 48) and low(L;n = 47) received 2.5 mg· kg−1, 2.0 mg· kg−1, and 1.5 mg· kg−1 of propofol respectively, Atracurium (0.5 mg· kg−1) was then injected and tracheal intubation performed once complete block was achieved at the orbicularis oculi. Patients from group without atracurium (WA;n = 20) received propofol as in group H. Intubation was performed at the expected onset time of action of atracurium.

Resulte

Using the same dose of propofol, the incidence of good or excellent intubating conditions was 35% without atracurium and 95% with atracurium (P < 0,0001), In patients receiving atracurium, clinically acceptable intubating conditions were more frequently achieved in groups receiving the highest propofol doses (group H or M vs group L;P < 0.03).

Conclusion

Our study confirms the interaction between anesthesia and muscle relaxation to produce adequate intubating conditions. In the conditions described, intubating conditions were more dependent on atracurium-induced neuromuscular blockade than on anesthetics, but both atracurium and propofol improved intubating conditions.

Keywords

Tracheal Intubation Rocuronium Alfentanil Atracurium Mivacurium 
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.

Les myorelaxants et des doses élevées de propofol améliorent les conditions d’intubation

Résumé

Objectif

Agents d’anesthésie et curares sont souvent associés pour l’intubation. Cependant, leurs rôles respectifs pendant l’intubation ne sont pas clairement définis. Cette étude a pour objectif de différencier pour l’intubation i) l’effet des agents d’anesthésie de ceux du bloc moteur induit par l’atracurium et ii) le rôle de différentes doses de propofol couplées à un bloc moteur complet induit par l’atracurium.

Méthode

Les patients étaient randomisés en quatre groupes. Tous recevaient du fentanyl et une procédure d’anesthésie standardisée. Les patients des groupes high (H; n = 45), medium (M; n = 48), et low (L; n = 47) recevaient respectivement 2,5 mg· kg−1, 2,0 mg· kg−1 et 1,5 mg· kg−1 de propofol puis atracurium 0,5 mg· kg−1. Lintubation était réalisée et cotée après qu’un bloc complet avait été obtenu à l’orbiculaire de l’œil. Les patients du groupe n’ayant pas reçu l’atracurium (WA) recevaient le propofol comme dans le groupe H, et étaient intubés après un intervalle de temps correspondant à celui du délai d’action supposé de l’atracurium.

Résultats

Chez les patients recevant des doses d’anesthésie équivalentes, les conditions d’intubation étaient significativement meilleures chez ceux recevant l’atracurium (groupe H) par rapport aux patients WA (P < 0,0001). Pour les patients recevant de l’atracurium, les conditions d’intubation étaient significativement meilleures chez les patients du groupe H ou M par rapport aux patients du groupe L (P < 0,03).

Conclusion

Les conditions d’intubation dépendent plus du bloc neuromusculaire que des agents d’anesthésie lorsque l’on attend l’installation complète du bloc. Cependant, les conditions d’intubation dépendent aussi du rôle des agents d’anesthésie lors de l’intubation avec une curarisation complète.

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Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Thomas Lieutaud
    • 1
    Email author
  • Valérie Billard
    • 1
  • Huguette Khalaf
    • 1
  • Bertrand Debaene
    • 2
  1. 1.Départements d’anesthésieInstitut Gustave RoussyVillejuif
  2. 2.CHU de PoitiersPoitiersFrance

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