ED50 and ED95 of Remifentanil for Intubation Without NOL Variation

• Status: Completed
• Trial end date: 2021-09-30
• Target enrollment: 0
• Participant gender: All

Summary

Our aim, in this study, is to elucidate the optimal dosing range (ED50 and ED95) of bolus remifentanil in order to counter the painful stimuli resulting from direct laryngoscopy and tracheal intubation by using the NOL index. In order to maximize the clinical relevance of our findings, induction of general anesthesia will be done with standard medications and doses and laryngoscopy will be done with the Macintosh laryngoscope, the most common tool used for intubation in the operating room

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Ciusss de L'Est de l'Île de Montréal
• Treatments: Remifentanil

Criteria

Inclusion Criteria:

• ASA status I or II

• Mallampati class I or II

• Patients > 18 years old and <65 years (defining elderly patients)

• Elective general, gynecological, orthopedic, plastic or urological surgery under general anesthesia

• Type of surgery that usually necessitate endotracheal intubation and controlled ventilation

Exclusion Criteria:

• Patient refusal

• History of psychiatric diseases or psychological problems (including mental retardation); inability to give consent; language barrier.

• Anticipated difficult airway (Mallampati class III and IV, thyromental distance < 6 cm, mouth opening < 3 cm, neck extension <80° and neck flexion <35°, inability to prognath, meaning bringing lower mandibular before the upper maxilla)

• Patient with history of neck rigidity or instability

• BMI > 30 kg/m2

• Anticipated difficult ventilation (patients with beard, obesity with BMI more than 30 kg/m2)

• Patient with history of oropharyngeal or tracheal surgery (excluding adenoidectomy, tonsillectomy and teeth removal)

• Severe coronary artery disease

• Serious cardiac arrhythmias (including atrial fibrillation)

• Use of β-blockers (all types)

• History of opioid or illicit drug substance abuse

• Chronic use of psychotropic and/or opioid drugs

• Allergy to remifentanil or propofol

• Pregnancy

• Contraindications to mask ventilation (gastrointestinal tract obstruction, pregnancy, active not-treated gastroesophageal reflux disease, non-fasting patients)

• Unexpected difficult airway requesting excessive, possibly painful airway manipulations

• Requiring hemodynamic support with vasopressors or inotropes 2 min before laryngoscopy to 5 min after insertion of endotracheal tube