The Optimal Dose of Remifentanil for Acceptable Intubating Conditions during Propofol Induction without Neuromuscular Blockade

Abstract

Study Objective: To determine the optimal remifentanil dose required to provide acceptable intubating conditions following induction of anesthesia with propofol without using neuromuscular blockade. Design: Dose-response study. Setting: Operating room of a university hospital. Patients: 50 ASA physical status 1 men, aged between 20 and 40 years, who were scheduled for general anesthesia. Interventions: Intubating conditions were evaluated according to the scoring system described by Viby-Mogensen et al. Successful intubation was defined as excellent or good. Measurements: For induction of anesthesia, an intravenous (IV) bolus dose of propofol 2.0 mg/kg was given over 30 seconds followed by the administration of predetermined IV remifentanil over 30 seconds; intubation was performed 90 seconds after completion of the remifentanil administration. The dose of remifentanil used for each patient was determined by the response of the previously tested patients, using the modified Dixon's up-and-down method (using 0.2 μg/kg as a step size). The first patient was tested with remifentanil 1.0 μg/kg. If intubation failed, the remifentanil dose was increased by 0.2 μg/kg; if intubation was successful, the dose was decreased by 0.2 μg/kg. Mean arterial pressure (MAP), heart rate (HR), and peripheral oxygen saturation were recorded during the study period. Main Results: According to probit analysis, the effective dose of remifentanil in 50% (ED <inf>50</inf>) and 95% (ED <inf>95</inf>) of patients were 1.40 μg/kg and 2.40 μg/kg, respectively. Preintubation and postinduction HR and MAP values were lower than preinduction values (P < 0.001). Conclusion: The optimal bolus dose of remifentanil for acceptable intubating conditions was 2.40 μg/kg (95% confidence interval, 1.90-9.0 μg/kg) in 95% of patients during induction of anesthesia with propofol 2.0 mg/kg without neuromuscular blocking agents. © 2012 Elsevier Inc. All rights reserved.