In conclusion, our results show the superiority of the propofol-remifentanil scheme, to provide acceptable clinical conditions of orotracheal intubation without muscle relaxant, even though they produce a hypotensor effect, higher than the one observed with the use of etomidate on the usual 0,3 mg/kg dose. Higher etomidate dose do not contribute any advantage with respect to the intubating conditions and, on the contrary, its hemodynamic behavior is closer to that of the propofol. 1. Rushman GB, Davies NJH, Atkinson RS. A short history of anaesthesia: intubation of the trachea. Oxford: Butterworth- Heinneman; 1996. p. 92-7. 2. Naguib M, Lien C. Pharmacology of muscle relaxants and their antagonists. En: Miller RD, editor. Anesthesia. Sixth edition. New York, NY: Pennsylvania: Churchill Livingstone Inc.; 2005. p. 481-572. 4. Scheller MS, Zornow MH, Saidman LJ. Tracheal intubation without the use of muscle relaxants: a technique using propofol and varying doses of alfentanil. Anesth Analg. 1992;75:788-93. 5. Davidson JA, Gillespie JA. Tracheal intubation after induction of anaesthesia with propofol, alfentanil and IV lidocaine. Br J Anaesth. 1993;70:163-6. 6. Hovorka J, Honkavaara P, Kortilla K. Tracheal intubation after induction of anaesthesia with thiopentone or propofol without muscle relaxants. Acta Anaesthesiol Scand. 1991;35:326-8. 7. Erhan E, Ugur G, Gunusen I, Alper I, Ozyar B. Propofol, not thiopental or etomidate, with remifentanil provides adequate intubating conditions in the absence of neuromuscular blockade. Can J Anesth. 2003;50:108-15. 8. Coghlan SFE, McDonald PF, Csepregi G. Use of alfentanil with propofol for nasotracheal intubation without neuromuscular block. Br J Anaesth. 1993;70:89-91. 9. Klemola UM, Mennander S, Saarnivaara L. Tracheal intubation without the use of muscle relaxants: remifentanyl or alfentanyl in combination with propofol . Acta Anaesthesiol Scand. 2000;44:465-9. 10. Erhan E, Ugur G, Alper I, Gunusen I, Ozyar B. Tracheal intubation without muscle relaxants: remifentanyl or alfentanyl in combination with propofol. Eur J Anaesth. 2003;20:37- 43. 11. Taha S, Siddik-Sayyid S, Alameddine M, Wakim C, Dahabra C, Moussa A, et al. Propofol is superior to thiopental for intubation without muscle relaxants. Can J Anaesth. 2005;52:249-53. 12. Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients using remifentanyl and propofol without muscle relaxants. Anesth Analg. 1998;86:45-9. 14. Scheffer GJ, Voorde BJ, Karemaker JM, Ros HH, De Lange JJ. Effects of thiopentone, etomidate, and propofol on beat to beat cardiovascular signals in man. Anaesthesia. 1993;48:849-55. 16. Viby-Mogensen J, Engbaek J, Eriksson LI, Gramstad L, Jensen E, Jensen FS, et al. Good clinical research practice GCRP in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996;40:59-74. 17. Prakash S, Arora D, Prakash S, Bhartiya V, Singh R. A combination of fentanyl-midazolam-propofol provides better intubating conditions than fentanyl-lignocaine-propofol in absence of neuromuscular blocking agents. Acta Anaesthesiol Scand. 2006;50:999-1004. 18. Stevens JB, Vescovo MV, Harris KC, Walker S, Hickey R. Tracheal intubation using alfentanyl and no muscle relaxant: is the choice of hypnotic important? Anesth Analg. 1997;84:1222-6. 19. Yukioka H, Yoshimoto N, Nishimura K, Fujimori M. Intravenous lydocaine as a suppressant of coughing during tracheal intubation. Anesth Analg. 1985;64:1189-92. 20. Hamill JF, Bedford RF, Weaver DC, Colohan AR. Lydocaine before endotracheal intubation: Intravenous or laryngotracheal. Anesthesiology. 1981;55:578-81. 21. Woods AW, Allam S. Tracheal intubation without the use of neuromuscular blocking agents. Br J Anaesth. 2005;94:150-8. 22. Reves JG, Glass PSA, Lubarsky DA. Nonbarbiturate intravenous anesthetics. En: Miller RD, editor. Anesthesia. Sixth edition. New York: Churchill Livingstone; 2005. p. 259-60. 23. Grogan K, Nyhan D, Berkowitz DE. Pharmacology of anesthetic drugs. Cardiac Anesthesia. 5th edition. En: Kaplan JA, editor. Philadelphia, PA.: Saunders Elsevier; 2006. p. 186-7.
En conclusión, nuestros resultados demuestran la superioridad del esquema propofol-remifentanilo para proveer condiciones clínicamente aceptables de intubación orotraqueal sin relajante neuromuscular aunque producen un efecto hipotensor mayor que el observado con etomidato a las dosis usuales de 0,3 mg/kg. Dosis superiores de etomidato no aportan una ventaja respecto a las condiciones de intubación y, por el contrario, su comportamiento hemodinámico se acerca más al del propofol.