Tracheal Intubation Without Use of Muscle Relaxants: Comparison of Remifentanil and Alfentanil

My objective is to analyze the efficiency of remifentanil- propofol and alfentanil-propofol combinations for laryngoscopic endotracheal intubation in the absence of muscle relaxants. This analysis reviews the work by Imani et al. (1). Muscle relaxants are frequently used to facilitate endotracheal intubation during anesthesia induction. However, the administration of short-acting depolarizing muscle relaxants is closely related to postoperative myalgias, malignant hyperthermia, hyperkalemia, and increased intracranial or intraocular pressure. Using non-depolarizing muscle relaxants may produce prolonged neuromuscular blockade, potentiate histamine release, increase the side effects from anticholinesterases used for reversing the agents, and lead to an inability to quickly reverse the blockade in the event of an unexpected difficult intubation. When using muscle relaxants is undesirable or contraindicated, it is important to administer other, proper induction agents to provide good intubating conditions (1, 2).