BACKGROUND: Using alfentanil followed by an anesthetic induction dose of propofol provides adequate conditions for tracheal intubation without neuromuscular blocking drugs in most patients. Providing an option for intense opioid effect without compromising recovery after short operations, remifentanil might offer benefits over alfentanil. In this study intubating conditions after remifentanil-propofol were evaluated.

METHODS: Sixty healthy premedicated patients were divided randomly into 3 groups. Anesthesia was intravenously induced with propofol (4 µg/ml) followed by remifentanil. Group R₂, R₃, R₄ received 2, 3, 4 µg/kg remifentanil, respectively. Ninety seconds after the administration of remifentanil, laryngoscopy and intubation were attempted. Intubation conditions were assessed as excellent, good or poor. The hemodynamic changes were measured at preinduction (base), preintubation, postintubation (immediately, 3 minute, 5 minute after intubation).

RESULTS: Clinically acceptable intubating conditions were observed in 65%, 95%, and 95% of patients in the R₂, R₃, and R₄ groups, respectively. Clinically acceptable intubating conditions were significantly (P < 0.05) less likely to occur in Group R₂. The mean arterial pressure decreased immediately after induction in all groups. There was no significant elevation in heart rate after tracheal intubation in all groups. There were no significant differences among groups.

CONCLUSIONS: Healthy, premedicated patients with favorable airway anatomy can be reliably intubated with good or excellent conditions 90 seconds after the administrations of remifentanil 3-4 µg/kg and propofol.