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Dose of alfentanil needed to obtain optimal intubation conditions during rapid-sequence induction of anaesthesia with thiopentone and rocuronium.

Author(s): Abou-Arab MH, Heier T, Caldwell JE

Affiliation(s): Department of Anesthesia, Aker University Hospital, Oslo, Norway.

Publication date & source: 2007-05, Br J Anaesth., 98(5):604-10. Epub 2007 Apr 2.

BACKGROUND: /st> The primary aim of the present study was to determine the dose of alfentanil that must be added to a rapid-sequence induction (RSI) regimen using thiopentone and rocuronium to obtain optimal intubation conditions in >95% of the individuals. METHODS: /st> A total of 60 ASA I patients were randomly allocated to five different alfentanil dose groups (0, 15, 30, 45, or 60 microg kg(-1)). A blinded dose of alfentanil followed by thiopentone 4 mg kg(-1) and rocuronium 1 mg kg (-1) was administered in rapid succession, and tracheal intubation was attempted 40 s thereafter. The relationship between the alfentanil dose and the probability of optimal intubation conditions was determined by non-linear logistic regression analysis. Blood pressure (BP) changes were recorded continuously using an intra-arterial catheter. RESULTS: /st> The success rate of optimal intubation conditions increased with increasing doses of alfentanil. The alfentanil dose needed to obtain optimal intubation conditions in >95% of the patients was 36.4 (CI 33.4-39.4) mug kg(-1). In 12 patients, the systolic BP declined to <90 mm Hg during the 3 min immediately after intubation. CONCLUSION: /st> Adding 36-40 microg kg(-1) alfentanil to a regimen of thiopentone and rocuronium during RSI of anaesthesia may significantly increase the success rate of optimal intubation conditions. Significant hypotension requiring vasopressor treatment may occur.

Page last updated: 2007-05-03

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