Endotracheale Intubation unter Propofol und Fentanyl

The routine use of succinylcholine for endotracheal intubation is being increasingly questioned. Initial studies have suggested that a combination of propofol and alfentanil without a muscle relaxant can provide good intubating conditions. However, most of these initial studies either did not have a double-blind design or did not include a control group with muscle relaxants. In this study, intubation conditions using fentanyl/propofol without a muscle relaxant were compared with the combinations of fentanyl/propofol/succinylcholine and sodium thiopental/succinylcholine. Material and methods. Following approval from the local ethics committee and written consent, 100 gynaecological patients (ASA I, II) were included in this study. The study was carried out in a double blind, randomized and prospective manner. Black perfusor syringes and extension sets were used, and the drugs administered were diluted to equal volumes. For induction, group 1 (n=25) received 0.1?mg fentanyl, 1?mg vecuronium, sodium thiopental (demand-adapted) and succinylcholine 1?mg/kg; group 2 (n=25) received 0.1?mg fentanyl and propofol (demand-adapted); group 3 (n=25) received 0.2?mg fentanyl and propofol (demand-adapted); group 4 (n=25) received 0.1?mg fentanyl, 1?mg vecuronium, propofol (demand-adapted) and succinylcholine 1?mg/kg. Each patient was assessed prior to induction with regard to visualization of the pharynx (grade I–IV). Following induction, jaw relaxation (grade I–IV) and the laryngoscopic visualization of the glottis (grade I-IV) were assessed. During the intubation, the position and movements of the vocal cords (grade I-IV) and patient movement during and 1?min following the intubation were assessed. The overall assessment of the intubation was graded (grade I–IV) by the anaesthetist and the anaesthetic nurse. Postoperatively the patients were questioned regarding muscle pain (grade I–IV). Before, during and after endotracheal intubation arterial haemoglobin oxygen saturation, heart rate and arterial blood pressure were monitored. Results. There were no intergroup differences with regard to age, height, weight and preanaesthetic visualization of the pharynx. In group 1 an average of 5.5±1.2?mg/kg sodium thiopental was required. There were no significant differences in group 2, 3 and 4 with respect to the dose of propofol (2.4, 2.2 and 2.2?mg/kg). No intergroup differences were noted with regard to jaw relaxation, laryngoscopic visualization of the glottis and patients' movements during intubation. Statistically significant intergroup differences occurred with regard to the position and movements of vocal cords during intubation (group 3 worse than groups 1, 2, 4) and the patients' movements 1?min after intubation (group 2 worse than group 3). Significant intergroup differences also occurred with regard to the overall assessment of the intubation by the anaesthetist (group 3 worse than groups 2, 4) and the anaesthetic nurse (group 3 wourse than group 4) and the postoperative muscle pain (group 1 worse than groups 2, 3). Conclusion. The use of 0.1?mg fentanyl/sodium thiopental/succinylcholine results in no better intubating conditions than 0.1?mg fentanyl plus propofol. Under these conditions, without the use of a muscle relaxant, it is possible to carry out safe endotracheal intubation in cases where no complications are anticipated.