DIPRIVAN(R) - INTUBATION WITHOUT CURARE

To intubate under ideal conditions, i.e. with the vocal cords abducted and no motor response to the insertion of the endotracheal tube, the anaesthetist has two alternatives : to use muscle relaxants or to anae sthetize the patient deeply. Apart from cases where muscle relaxants a re contra-indicated or required by the type of procedure: Intubation u sing muscle relaxants means: - maintaining the option of varying the d epth of anaesthesia, while keeping optimal conditions for intubation; - reducing the risk of airways trauma. Intubation without muscle relax ants means: - avoiding the risk of allergic complications; - producing deep anaesthesia and controlling any resulting haemodynamic effects. The recommended induction agent is propofol, given as a bolus injectio n at a dose equal to or greater than 2.5 mg . kg-1 in adults and 3.5 m g . kg-1 in children. Alfentanil is the opioid of choice, the dose bei ng between 30 and 40 mug . kg-1. Lidocaine, injected as premediation a t a dose of 1.5 mg . kg-1 potentiates the effect of alfentanil. The or der of injection of the induction agents is important, as it determine s the exact moment for laryngoscopy and intubation.