Dose of rocuronium for rapid tracheal intubation following remifentanil 2 μg kg-1 and propofol 2mg kg-1

摘要

CONTEXT Full relaxation is not mandatory for successful tracheal intubation. OBJECTIVE We tried to find the dose of rocuronium that gave acceptable intubation conditions in a rapid sequence intubation with remifentanil and propofol. DESIGN A dose-finding study of rocuronium using a modified Dixon's up-and-down method. SETTING A single tertiary care teaching hospital. PARTICIPANTS Patients undergoing elective surgery under general anaesthesia. INTERVENTIONS After premedication with midazolam and glycopyrrolate, anaesthesia was induced using remifentanil 2mg kg-1 and propofol 2mg kg-1, and a predetermined dose of rocuronium was administered. The dose of rocuronium was determined by a modified Dixon's up-and-down method starting from 0.8mg kg-1 with an interval of 0.1 or 0.05mg kg-1. Intubation was performed 60 s after the start of the rocuronium injection. Intubation conditions were graded as excellent, good or poor. Excellent or good were regarded as clinically acceptable. MAIN OUTCOME MEASURE A dose of rocuronium needed for acceptable intubation condition in 50% of patients (ED50) during rapid tracheal intubation after induction of anaesthesia with remifentanil and propofol. RESULTS Twenty-eight patients were enrolled to obtain six crossovers. The ED50 of rocuronium was 0.20mg kg -1 (95% confidence interval, CI 0.17 to 0.23mg kg-1) by a modified Dixon's up-and-down method. CONCLUSION After induction of anaesthesia with remifentanil 2mgkg-1 and propofol 2mg kg-1, theED50 of rocuronium for acceptable intubation condition was 0.20mg kg-1 (95% CI, 0.17 to 0.23mg kg-1) for rapid sequence intubation. Thus, we recommend that the intubation dose should be 0.8mg kg-1.