Comparison of intubation conditions and apnea time after anesthesia induction with propofol/remifentanil combined with or without small dose of succinylcholine.

BACKGROUND: Many scholars are seeking for an anesthesia induction regimen to meet the requirements of both intubation and instant recovery of spontaneous breathing in case of "cannot intubate, cannot ventilate" to prevent severe consequences. This study aims to investigate whether the combination use of remifentanil 1 μg/kg and small dose of succinylcholine (0.6 mg/kg) is superior to single use of remifentanil 1.5 μg/kg in improving intubation conditions and shortening apnea time under anesthesia induction with propofol.
METHODS: Sixty patients undergoing selective gynecological laparoscopic operation under general anesthesia were included into the prospective randomized controlled trial. After sufficient preoxygenation, all patients received propofol for anesthesia induction, and patients in group S were managed with remifentanil 1 μg/kg and succinylcholine 0.6 mg/kg, while those in group C were treated with remifentanil 1.5 μg/kg and normal saline. Tracheal intubation was conducted 60 s later, and mechanical ventilation was not performed until spontaneous breathing emerged. The intubation conditions were evaluated, and the apnea time between induction and breathing recovery was recorded.
RESULTS: One patient (3.70%) in group S was graded as poor in intubation conditions, which was significantly fewer than 12 patients in group C (P<0.001). There was no significant difference in apnea time between two groups (245.50 ± 53.71 vs 251.12 ± 70.71, P=0.750). No patient experienced hypoxic event with SpO2<90% before recovery of spontaneous breathing.
CONCLUSIONS: Compared with single use of remifentanil 1.5 μg/kg, the combination use of remifentanil 1 μg/kg and succinylcholine 0.6 mg/kg may offer better intubation conditions and may not prolong apnea time under anesthesia induction with propofol 2 mg/kg.

RCT Entities:   Population Interventions Outcomes