Efficacy of induction with sevoflurane-midazolam-remifentanil for tracheal intubation without muscle relaxants

Abstract

Objective To evaluate the efficacy of induction with sevoflurane-midazolam-remifentanil for tracheal intubation without muscle relaxants.Methods Thirty ASA Ⅰ or Ⅱ patients,aged 20-55 yr,weighing 50-80 kg,scheduled for elective surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of midazolam 0.03 mg/kg and sevoflurane inhalation.Sevoflurane was inhaled initially with high-flow oxygen(5 L/min).Sevoflurane anesthetic vaporizer dial was set at 3% followed by increment of 1% every 3 times of respiration until 6% .When the patient's eyelash reflex disappeared,remifentanil 2 μg/kg was injected slowly over 1 min and 30 s later sevoflurane inhalation was then stopped.The patients were mechanically ventilated after tracheal intubation.MAP,HR,SpO2and BIS were recorded before administration,at the time of disappearance of eyelash reflex,immediately before tracheal intubatiun,and immediately after tracheal intobation.The time period from sevoflurane inhalation to disappearance of eyelash reflex was also recorded.Results All patients were successfully intubated at the first attempt.The satisfactory intubation conditions were found in 80% of cases.The time period from sevoflurane inhalation to disappearance of eyelash reflex was (210±12)s.MAP HR and SpO2remained stable and BIS value was maintained at 45-55 before and after tracheal intubation.Conclusion Induction with sevoflurane-midazolam-remifentanil is smooth and can be used for tracheal intubation without muscle relaxants. Key words: Anesthetics,inhalation; Midazolam; Piperidines ; Intubation,intratracheal