Sevoflurane at 1.0 MAC together with remifentanil and propofol produces clinically acceptable intubation conditions at the vocal cords: A prospective randomized study

Attila Ovari, Ilona Bicker, Susann Machmueller, Tobias Schuldt, Martin Sauer, Stefan Soltesz, Gabriele Noeldge-Schomburg, Robert Mlynski, Thomas Mencke, Attila Ovari, Ilona Bicker, Susann Machmueller, Tobias Schuldt, Martin Sauer, Stefan Soltesz, Gabriele Noeldge-Schomburg, Robert Mlynski, Thomas Mencke

Abstract

Objective The overall intubation conditions after tracheal intubation with remifentanil, propofol, and sevoflurane at 1.0 minimum alveolar concentration (MAC) are worse than with rocuronium at 0.45 mg/kg. Therefore, we compared the intubation conditions and laryngeal morbidity (vocal cord injuries, hoarseness, and sore throat) with sevoflurane at 1.2 and 1.4 MAC versus 1.0 MAC. Methods In this prospective clinical trial, 90 patients were randomized to 3 groups: the sevoflurane 1.0, 1.2, and 1.4 MAC groups. At 3 min, tracheal intubation was performed and the patients' intubation conditions were assessed. The vocal cords were examined for injury by videolaryngoscopy. Additionally, the incidence and severity of laryngeal morbidity were compared between women and men. Results Acceptable intubation conditions were seen in 72% of the patients without significant differences between the groups. Overall, vocal cord injuries (oedema) occurred in three (4%) patients. Women reported sore throat more often than men (51% vs. 21%, respectively). Conclusions Intubation conditions were not improved with higher sevoflurane concentrations. The incidence and severity of sore throat were greater in women than men.

Trial registration: ClinicalTrials.Gov: NCT 01896245.

Trial registration: ClinicalTrials.gov NCT01896245.

Keywords: Sevoflurane; intubation conditions; laryngeal injury; remifentanil; sex; sore throat.

Figures

Figure 1.
Figure 1.
Flow chart of patient distribution. Laryngoscopy after surgery was not possible in 16 patients.
Figure 2.
Figure 2.
Intubation conditions at the vocal cords; patients (%) with excellent (black bars), good (grey bars), and poor intubation conditions (white bars).
Figure 3.
Figure 3.
Oedema (arrows) and erythema (circles) of both vocal folds at 24 h after surgery. This patient had a pre-existing minimal haemangioma of the left vocal fold (cross). RVF = right vocal fold, LVF = left vocal fold, EG = epiglottis.
Figure 4.
Figure 4.
Severity of sore throat in women and men. Women and men of the Sevo 1.0, 1.2, and 1.4 MAC groups were pooled. Intensity of sore throat was assessed with a numeric analogue scale ranging from 0 to 10: 0 = no sore throat, 1–3 = mild sore throat, 4–6 = moderate sore throat, 7–9 severe sore throat, and 10 = worst possible sore throat. Box plots show median (line and line within box), quartiles (line and box), 10th and 90th percentiles (error bars), and outlying points. Sevo = sevoflurane, MAC = minimum alveolar concentration.
Figure 5.
Figure 5.
Days with sore throat in women and men. Women and men of the Sevo 1.0, 1.2, and 1.4 MAC groups were pooled. Box plots show median (line and upper line of box), quartiles (line and box), 10th and 90th percentiles (error bars), and outlying points. Sevo = sevoflurane, MAC = minimum alveolar concentration.

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