A blinded randomized study comparing intubating conditions after either rocuronium 0.6 mg·kg-1 or remifentanil 2 µg·kg-1 in elderly patients.

Abstract

To facilitate tracheal intubation, either a neuromuscular blocking agent or a bolus dose of remifentanil can be administered. We hypothesized that rocuronium 0.6mg·kg-1 provided a larger proportion of excellent intubating conditions compared to remifentanil 2µg·kg-1 in patients above 80years. A total of 78 patients were randomized to either rocuronium 0.6mg·kg-1 or remifentanil 2µg·kg-1 . General anaesthesia was initiated with fentanyl and propofol. Two minutes after the administration of either rocuronium or remifentanil, tracheal intubating conditions were evaluated using the Fuchs-Buder scale by a blinded investigator, and our primary outcome was the proportion of patients presenting intubating conditions deemed as excellent. Further outcomes included the Intubating Difficulty Scale (IDS), hoarseness or sore throat 24h postoperatively, and intervention against hypotension. No difference in the occurrence of excellent intubating conditions was found comparing the rocuronium group with the remifentanil group; 10 (28%) versus 15 (39%) (p=.29), respectively, relative risk=0.72. Interventions against hypotension were used in 24 (67%) versus 28 (74%) (p=.51), respectively. Hoarseness and sore throat 24h postoperatively were found in 37% versus 35% p=.86, and 14% versus 5% p=.20, respectively. The IDS score was 2 versus 2 p=.48. No difference in intubating conditions was found 2min after the administration of either rocuronium 0.6mg·kg-1 or remifentanil 2µg·kg-1 in patients aged above 80years. Intubation conditions were less than optimal in a large proportion of this patient population. NCT04287426.