Do we need inhaled anaesthetics to blunt arousal, haemodynamic responses to intubation after i.v. induction with propofol, remifentanil, rocuronium?

Background The aim of this study was to determine whether, after propofol, rocuronium and remifentanil rapid sequence induction, inhaled anaesthetic agents should be started before intubation to minimize autonomic and arousal response during intubation. Methods One hundred ASA I and II patients were randomized to receive 1 MAC of desflurane or sevoflurane during manual ventilation or not. Anaesthesia was induced with an effect-site-controlled infusion of remifentanil at 2 ng ml−1 for 3 min. Patients then received propofol to induce loss of consciousness (LOC). Rocuronium (0.6 mg kg−1) was given at LOC and the trachea was intubated after 90 s of manual breathing support (=baseline) with or without inhaled anaesthetics. Vital signs and bispectral index (BIS) were recorded until 10 min post-intubation to detect autonomic and arousal response. Results A significant increase in BIS value after intubation was seen in all groups. The increases were mild, even in those not receiving pre-intubation inhaled anaesthetics. However, in contrast to sevoflurane, desflurane appeared to partially blunt the arousal response. Heart rate, systolic and diastolic pressure increase similarly in all groups. Conclusions Desflurane and sevoflurane were unable to blunt the arousal reflex completely, as measured by BIS, although the reflex was significantly less when desflurane was used. Rapid sequence induction with remifentanil, propofol and rocuronium and without inhaled anaesthetics before intubation can be done without dangerous haemodynamic and arousal responses at intubation after 90 s.