ENDOTRACHEAL INTUBATION UNDER PROPOFOL, ASSOCIATED OR NOT WITH VECURONIUM

Objective: In order to test the hypothesis that under the association propofol-alfentanil-IV lidocaine the trachea could be intubated easily without an additional muscle relaxant, this study compared the intubation conditions when this association was combined or not with vecuronium. Study design: Randomized comparative trial. Patients: The study included 152 young adults classified as ASA physical class I and Mallampati presentation grade 1, randomly allocated either into Vecu+ group or Vecu0 group, depending on whether vecuronium was coadministered or not. Methods: All patients received midazolam 0.05 mg . kg(-1) i.v., one minute before induction. Those of group Vecu0 were given successively within two minutes: alfentanil 0.03 mg . kg(-1), lidocaine 1.5 mg . kg(-1) i.v. and propofol 2.5 mg . kg(-1). Patients of group Vecu+ received similar doses of alfentanil and propofol as well as vecuronium 0.08 mg . kg(-1). The endotracheal tube was inserted one minute after induction in the patients of Vecu0 group, and after three minutes in those of the Vecu+ group. During intubation, scores of mouth opening, glottis opening and coughing were established, in order to assess intubation conditions. Results: Similar convenient intubating conditions were obtained in both groups (in 97 % of patients in Vecu+ group vs 95 % of those in Vecu0 group). In the latter, the glottis opening was less pronounced. Conclusions: In young healthy adults, without anaesthetic risk (emergency, full stomach) and without foreseen difficult intubation, the endotracheal tube can be inserted in convenient conditions without a muscle relaxant, under the association propofol-alfentanil-lidocaine iv.