A blinded randomized study comparing intubating conditions after either rocuronium 0.6 mg·kg−1 or remifentanil 2 µg·kg−1 in elderly patients. Issue 10 (5th September 2021)

• Record Type: Journal Article
• Authors: Vested, Matias; Sørensen, Anne Marie; Bjerring, Cecilie; Christensen, Rasmus E.; Dinesen, Felicia; Vang, Malene; Gilvanoff, Alexander; Hansen, Thea Ellehammer; Nielsen, Tatiana; Rasmussen, Lars S.
• Is Part Of: Acta anaesthesiologica scandinavica. Volume 65:Issue 10(2021)
• Page Start: 1367
• Page End: 1373
• Publication Date: 2021-09-05
• Subjects: elderly patients -- neuromuscular blocking agents -- tracheal intubating conditions; Anesthesiology -- Periodicals; Critical care medicine -- Periodicals; 617.9605
• DOI: 10.1111/aas.13957
• Languages: English
• ISSNs: 0001-5172

Abstract

Abstract: Background: To facilitate tracheal intubation, either a neuromuscular blocking agent or a bolus dose of remifentanil can be administered. We hypothesized that rocuronium 0.6 mg·kg −1 provided a larger proportion of excellent intubating conditions compared to remifentanil 2 µg·kg −1 in patients above 80 years. Methods: A total of 78 patients were randomized to either rocuronium 0.6 mg·kg −1 or remifentanil 2 µg·kg −1 . General anaesthesia was initiated with fentanyl and propofol. Two minutes after the administration of either rocuronium or remifentanil, tracheal intubating conditions were evaluated using the Fuchs‐Buder scale by a blinded investigator, and our primary outcome was the proportion of patients presenting intubating conditions deemed as excellent. Further outcomes included the Intubating Difficulty Scale (IDS), hoarseness or sore throat 24 h postoperatively, and intervention against hypotension. Results: No difference in the occurrence of excellent intubating conditions was found comparing the rocuronium group with the remifentanil group; 10 (28%) versus 15 (39%) ( p = .29), respectively, relative risk = 0.72. Interventions against hypotension were used in 24 (67%) versus 28 (74%) ( p = .51), respectively. Hoarseness and sore throat 24 h postoperatively were found in 37% versus 35% p = .86, and 14% versus 5% p = .20, respectively. The IDS score was 2 versus 2 p = .48. Conclusion: No difference in intubating conditions was found 2 min after the administration of either rocuronium 0.6 mg·kg −1 or remifentanil 2 µg·kg −1 in patients aged above 80 years. Intubation conditions were less than optimal in a large proportion of this patient population. Clinical trials registration: NCT04287426.