Dexmedetomidine Improves Intubating Conditions Without Muscle Relaxants in Children After Induction With Propofol and Remifentanil.

Abstract

Anesthesia induction using propofol (3 mg/kg) and remifentanil (2 μg/kg) without the use of muscle relaxants has been associated with a lower incidence of successful intubation. Dexmedetomidine has been found to effectively decrease the requirements for propofol and remifentanil and to attenuate the hemodynamic response to intubation. Therefore, in this study, we examined intubating conditions and hemodynamic changes in children after induction with dexmedetomidine (1 μg/kg) combined with propofol (3 mg/kg) and remifentanil (2 μg/kg). This randomized, double-blinded, and placebo-controlled study included 60 ASA physical status I children aged 5 to 10 years. The children were randomly allocated to a dexmedetomidine group (group D) or a placebo group (group P). After IV administration of atropine (0.01 mg/kg), anesthesia was induced with an infusion of dexmedetomidine (1 μg/kg) over 2 minutes for group D, whereas normal saline was infused for group P. Propofol (3 mg/kg) was then injected IV over 20 to 30 seconds, followed by an infusion of remifentanil (2 μg/kg) over 1 minute for both groups. One minute later, laryngoscopy and tracheal intubation were performed. For group D and group P, tracheal intubation was successful in 90% (27/30) and 53% (16/30) of patients (P = 0.0034), respectively. Excellent conditions were present in 22 of 27 and 8 of 16 of intubations, respectively, resulting in an overall incidence of excellent conditions of 73% (22/30) and 27% (8/30), respectively (P = 0.0007). Systolic blood pressure significantly increased after the IV injection of dexmedetomidine compared with baseline readings (P = 0.012, with a confidence interval of 2-22 mm Hg). A single dose of dexmedetomidine (1 μg/kg) improved intubation conditions in children after induction with propofol (3 mg/kg) and remifentanil (2 μg/kg) without muscle relaxants. Dexmedetomidine did not affect the hemodynamic response to intubation.