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- W1965092837 abstract "Alexander and Fardell report the use of remifentanil for tracheal intubation for a Caesarean section in a patient with succinylcholine apnoea [1]. It is encouraging that airway management was successful, but their technique raises some issues. The authors used an infusion of remifentanil at 0.25 μg.kg−1 min−1 followed by a bolus of 0.5 μg.kg−1. The optimal dose of remifentanil for intubation without the use of neuromuscular blockade has not been determined. The dose regimen reported is markedly different from those previously described in the literature for intubation without the use of neuromuscular blockade. McNeil and colleagues demonstrated that remifentanil 4 μg.kg−1 combined with propofol was required to produce intubating conditions comparable to succinylcholine [2]. This dose of remifentanil was associated with significant cardiovascular depression and a mean duration of apnoea of 12.8 min. Some authors have noted that doses of 2 μg.kg−1 provide good intubating conditions in 80–90% of elective patients, whereas others have stated that doses of 4 μg.kg−1 are required [3]. Whether a success rate of 80–90% is adequate during a rapid sequence induction is questionable. Failure to intubate even with doses as high as 3–4 μg.kg−1 has been described. Klemola found that in patients given propofol and remifentanil 3 μg.kg−1 or 4 μg.kg−1, tracheal intubation was not possible in 25% and 5% of cases, respectively [4]. Most studies using remifentanil for tracheal intubation without neuromuscular blockers have used propofol as the induction agent and thiopental may not provide similar intubating conditions. Erhan and colleagues showed that propofol 2 mg.kg−1 provided significantly better intubating conditions than thiopental 6 mg.kg−1 when combined with remifentanil 3 μg.kg−1[5]. Acceptable intubating conditions were found in only 67% of patients in the thiopental group and 20% of patients could not be intubated at the first attempt. Durumus et al. showed that only doses of 4 μg.kg−1 of remifentanil provided ‘excellent’ or ‘satisfactory’ intubating conditions when combined with thiopental 5 mg.kg−1[6]. There is limited data on the use of remifentanil during rapid sequence induction. Haughton and colleagues described the successful use of propofol with remifentanil 4 μg.kg−1 in a trauma patient with a family history of malignant hyperpyrexia [7]. Airway management for obstetric anaesthesia must be safe, effective and reliable. The drugs and dosages used by Alexander and Fardell may not work for other patients. Even though recovery from neuromuscular blockade would be prolonged, an intubation strategy using succinylcholine or rocuronium is an appropriate choice for the case described." @default.
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- W1965092837 date "2006-02-01" @default.
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- W1965092837 title "Remifentanil for tracheal intubation" @default.
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- W1965092837 doi "https://doi.org/10.1111/j.1365-2044.2005.04521_2.x" @default.
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