Skip to main content
    • Aa
    • Aa

Tracheal intubation without muscle relaxants: remifentanil or alfentanil in combination with propofol

  • E. Erhan (a1), G. Ugur (a1), I. Alper (a1), I. Gunusen (a1) and B. Ozyar (a1)...


Background and objective: In some situations, the use of muscle relaxants (neuromuscular blocking drugs) are undesirable or contraindicated. We compared intubating conditions without muscle relaxants in premedicated patients receiving either alfentanil 40 μg kg−1 or remifentanil 2, 3 or 4 μg kg−1 followed by propofol 2 mg kg−1.

Methods: In a randomized, double-blind study, 80 healthy patients were assigned to one of four groups (n = 20). After intravenous atropine, alfentanil 40 μg kg−1 or remifentanil 2, 3 or 4 μg kg−1 were injected over 90 s followed by propofol 2 mg kg−1. Ninety seconds after administration of the propofol, laryngoscopy and tracheal intubation were attempted. Intubating conditions were assessed as excellent, good or poor on the basis of ease of lung ventilation, jaw relaxation, laryngoscopy, position of the vocal cords, and patient response to intubation and slow inflation of the endotracheal tube cuff.

Results: Seven patients who received remifentanil 2 μg kg−1 and one patient who received remifentanil 3 μg kg−1 could not be intubated at the first attempts. Excellent intubating conditions (jaw relaxed, vocal cords open and no movement in response to tracheal intubation and cuff inflation) were observed in those who received either alfentanil 40 μg kg−1 (45% of patients) or remifentanil in doses of 2 μg kg−1 (20%), 3 μg kg−1 (75%) or 4 μg kg−1 (95%). Overall, intubating conditions were significantly better (P < 0.05), and the number of patients showing excellent conditions were significantly higher (P < 0.05) in patients who received remifentanil 4 μg kg−1 compared with those who received alfentanil 40 μg kg−1 or remifentanil 2 μg kg−1. No patient needed treatment for hypotension or bradycardia.

Conclusions: Remifentanil 4 μg kg−1 and propofol 2 mg kg−1 administered in sequence intravenously provided good or excellent conditions for tracheal intubation in all patients without the use of muscle relaxants.

Corresponding author
Correspondence to: Elvan Erhan, Mithatpasa cad. 959/3, 35290 Guzelyali, Izmir, Turkey. E-mail:; Tel: +90 542 4143685; Fax: +90 232 2479783
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

SchellerMS, ZornowMH, SaidmanLJ. Tracheal intubation without the use of muscle relaxants: a technique using propofol and varying doses of alfentanil.Anesth Analg1992; 75: 788793.

BeckGN, MastersonGR, RichardsJ, BuntingP. Comparison of intubation following propofol and alfentanil with intubation following thiopentone and suxamethonium.Anaesthesia1993; 48: 876880.

DavidsonJA, GillespieJA. Tracheal intubation after induction of anaesthesia with propofol, alfentanil and IV lidocaine.Br J Anaesth1993; 70: 163166.

ThompsonJP, RowbothamDJ. Remifentanil – an opioid for the 21st century.Br J Anaesth1996; 76: 341343.

GlassPSA, HardmanD, KamiyamaY, et al. Preliminary pharmacokinetics and pharmacodynamics of an ultra-short-acting opioid: remifentanil (G187084B).Anesth Analg1993; 77: 10311040.

EganTD, MintoCF, HermannDJ, et al. Remifentanil versus alfentanil: comparative pharmacokinetics and pharmacodynamics in healthy adult male volunteers.Anesthesiology1996; 84: 821833.

MallampatiS, GattS, GuginoLD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study.Can J Anaesth1985; 32: 429434.

StevensJB, WheatleyL. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants.Anesth Analg1998; 86: 4549.

KleomolaUM, MennanderS, SaarnivaaraL. Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol.Acta Anaesthesiol Scand2000; 44: 465469.

WoodsAW, GrantS, DavidsonJA. Duration of apnoea with two different intubating doses of remifentanil.Eur J Anaesthesiol1999; 16: 634637.

GrantS, NobleS, WoodsA, MurdochJ, DavidsonJAH. Assessment of intubating conditions in adults after induction with propofol and varying doses of remifentanil.Br J Anaesthesia1998; 81: 540543.

KazamaT, IkedaK, MoritaK. Reduction by fentanyl of the Cp50 values of propofol and hemodynamic responses to various noxious stimuli.Anesthesiology1997; 87: 213227.

AlexanderR, OlufolabiA, BoothJ, El MoalemH, GlassPS. Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants.Anaesthesia1999; 54: 10371040.

WoodsAW, GrantS. Remifentanil and intubating conditions.Anaesthesia2000; 55: 516518.

ThompsonJP, HallAP, RussellJ, CagneyB, RowbothamDJ. Effect of remifentanil on the haemodynamic response to orotracheal intubation.Br J Anaesth1998; 80: 467469.

SebelPS, HokeJF, WestmorelandC, et al. Histamine concentrations and hemodynamic responses after remifentanil.Anesth Analg1995; 80: 990993.

DingY, FredmanB, WhitePF. Use of mivacurium during laparoscopic surgery: effect of reversal drugs on postoperative recovery.Anesth Analg1994; 78: 450454.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

European Journal of Anaesthesiology
  • ISSN: 0265-0215
  • EISSN: 1365-2346
  • URL: /core/journals/european-journal-of-anaesthesiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 0
Total number of PDF views: 1 *
Loading metrics...

Abstract views

Total abstract views: 172 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th September 2017. This data will be updated every 24 hours.