Abstract
Purpose
Muscle relaxants and anesthetics are usually associated during intubation. However, their relative role to facilitate the process is not dearly defined. This study was designed to determine, during intubation: i) the relative role of anesthetics and atracurium-induced neuromuscular block and; ii) the effect of different doses of propofol in the presence of complete muscle block.
Methods
Patients were randomized to four groups and received fentanyl and a standardized anesthetic procedure. Patients from groups high (H;n = 45), medium (M;n = 48) and low(L;n = 47) received 2.5 mg· kg−1, 2.0 mg· kg−1, and 1.5 mg· kg−1 of propofol respectively, Atracurium (0.5 mg· kg−1) was then injected and tracheal intubation performed once complete block was achieved at the orbicularis oculi. Patients from group without atracurium (WA;n = 20) received propofol as in group H. Intubation was performed at the expected onset time of action of atracurium.
Resulte
Using the same dose of propofol, the incidence of good or excellent intubating conditions was 35% without atracurium and 95% with atracurium (P < 0,0001), In patients receiving atracurium, clinically acceptable intubating conditions were more frequently achieved in groups receiving the highest propofol doses (group H or M vs group L;P < 0.03).
Conclusion
Our study confirms the interaction between anesthesia and muscle relaxation to produce adequate intubating conditions. In the conditions described, intubating conditions were more dependent on atracurium-induced neuromuscular blockade than on anesthetics, but both atracurium and propofol improved intubating conditions.
Résumé
Objectif
Agents d’anesthésie et curares sont souvent associés pour l’intubation. Cependant, leurs rôles respectifs pendant l’intubation ne sont pas clairement définis. Cette étude a pour objectif de différencier pour l’intubation i) l’effet des agents d’anesthésie de ceux du bloc moteur induit par l’atracurium et ii) le rôle de différentes doses de propofol couplées à un bloc moteur complet induit par l’atracurium.
Méthode
Les patients étaient randomisés en quatre groupes. Tous recevaient du fentanyl et une procédure d’anesthésie standardisée. Les patients des groupes high (H; n = 45), medium (M; n = 48), et low (L; n = 47) recevaient respectivement 2,5 mg· kg−1, 2,0 mg· kg−1 et 1,5 mg· kg−1 de propofol puis atracurium 0,5 mg· kg−1. Lintubation était réalisée et cotée après qu’un bloc complet avait été obtenu à l’orbiculaire de l’œil. Les patients du groupe n’ayant pas reçu l’atracurium (WA) recevaient le propofol comme dans le groupe H, et étaient intubés après un intervalle de temps correspondant à celui du délai d’action supposé de l’atracurium.
Résultats
Chez les patients recevant des doses d’anesthésie équivalentes, les conditions d’intubation étaient significativement meilleures chez ceux recevant l’atracurium (groupe H) par rapport aux patients WA (P < 0,0001). Pour les patients recevant de l’atracurium, les conditions d’intubation étaient significativement meilleures chez les patients du groupe H ou M par rapport aux patients du groupe L (P < 0,03).
Conclusion
Les conditions d’intubation dépendent plus du bloc neuromusculaire que des agents d’anesthésie lorsque l’on attend l’installation complète du bloc. Cependant, les conditions d’intubation dépendent aussi du rôle des agents d’anesthésie lors de l’intubation avec une curarisation complète.
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Lieutaud, T., Billard, V., Khalaf, H. et al. Muscle relaxation and increasing doses of propofol improve intubating conditions. Can J Anaesth 50, 121–126 (2003). https://doi.org/10.1007/BF03017842
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DOI: https://doi.org/10.1007/BF03017842