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BJA Advance Access originally published online on April 2, 2007
British Journal of Anaesthesia 2007 98(5):604-610; doi:10.1093/bja/aem064
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Dose of alfentanil needed to obtain optimal intubation conditions during rapid-sequence induction of anaesthesia with thiopentone and rocuronium

M. H. Abou-Arab1, T. Heier1,* and J. E. Caldwell2

1 Department of Anesthesia, Aker University Hospital, Oslo, Norway
2 Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA

* Corresponding author: Department of Anesthesia, Aker University Hospital, Trondheimsvn 235, 0514 Oslo, Norway. E-mail: tom.heier{at}medisin.uio.no

Background: The primary aim of the present study was to determine the dose of alfentanil that must be added to a rapid-sequence induction (RSI) regimen using thiopentone and rocuronium to obtain optimal intubation conditions in >95% of the individuals.

Methods: A total of 60 ASA I patients were randomly allocated to five different alfentanil dose groups (0, 15, 30, 45, or 60 µg kg–1). A blinded dose of alfentanil followed by thiopentone 4 mg kg–1 and rocuronium 1 mg kg –1 was administered in rapid succession, and tracheal intubation was attempted 40 s thereafter. The relationship between the alfentanil dose and the probability of optimal intubation conditions was determined by non-linear logistic regression analysis. Blood pressure (BP) changes were recorded continuously using an intra-arterial catheter.

Results: The success rate of optimal intubation conditions increased with increasing doses of alfentanil. The alfentanil dose needed to obtain optimal intubation conditions in >95% of the patients was 36.4 (CI 33.4–39.4) µg kg–1. In 12 patients, the systolic BP declined to <90 mm Hg during the 3 min immediately after intubation.

Conclusion: Adding 36–40 µg kg–1 alfentanil to a regimen of thiopentone and rocuronium during RSI of anaesthesia may significantly increase the success rate of optimal intubation conditions. Significant hypotension requiring vasopressor treatment may occur.

Keywords: analgesics opioid, alfentanil; induction, anaesthesia; intubation, tracheal tube


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Opioids and rapid-sequence induction
Mohammad El-Orbany
British Journal of Anaesthesia, 20 Jun 2007 [Full text]
Alfentanil and rocuronium during rapid-sequence induction of anaesthesia
tom heier
British Journal of Anaesthesia, 3 Jul 2007 [Full text]

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