TRACHEAL INTUBATION USING ALFENTANIL AND NO MUSCLE-RELAXANT - IS THE CHOICE OF HYPNOTIC IMPORTANT

Administration of alfentanil followed by propofol intravenously (IV) w ithout neuromuscular blockade for induction of anesthesia provides ade quate conditions for tracheal intubation. Other hypnotic drugs have no t been thoroughly investigated in this regard. Accordingly, 140 ASA ph ysical status I and II premedicated outpatients were randomly assigned to one of seven groups (n = 20/group). Patients in Groups I-VI receiv ed alfentanil 40 mu g/kg followed by etomidate 0.3 mg/kg, propofol 2 m g/kg, or thiopental 4 mg/kg. One half of these patients (Groups II, IV , VI) also received lidocaine 1 mg/kg IV prior to the administration o f the above drugs. Patients in group VII received d-tubocurarine 3 mg followed by thiopental 4 mg/kg and succinylcholine 1 mg/kg. Ninety sec onds after induction, laryngoscopy and endotracheal intubation were at tempted and graded. Patients in Group V (alfentanil/thiopental) were s ignificantly (P < 0.05) more likely to have a clinically unacceptable response to intubation (55%) (e.g., vigorous coughing, purposeful move ment, or requirement for succinylcholine to complete intubation) compa red with patients who received propofol (35%) or etomidate (20%). Alfe ntanil/etomidate yielded intubation conditions comparable to those ach ieved with alfentanil/propofol and d-tubocurarine/thiopental/succinylc holine. Lidocaine appeared to improve intubating conditions, although this improvement did not reach statistical significance. The results s uggest that healthy, premedicated patients with favorable airway anato my who have received alfentanil 40 mu g/kg can be reliably tracheally intubated 90 s after administration of propofol 2 mg/kg or etomidate 0 .3 mg/kg.