A combination of alfentanil-lidocaine-propofol provides better intubating conditions than fentanyl-lidocaine-propofol in the absence of muscle relaxants.

Purpose: To compare the ease of tracheal intubation without the use of muscle relaxants following an alfentanil-lidocaine-propofol sequence vs a fentanyl-lidocaine-propofol sequence.

Clinical Features: In 80 ASA I and II adult patients undergoing elective laparoscopic surgery, we compared the intubating conditions following alfentanil 20 microg x kg(-1), lidocaine 1.5 mg x kg(-1), propofol 3 mg x kg(-1) (Group I; n = 40) vs fentanyl 2 microg x kg(-1), lidocaine 1.5 mg x kg(-1), propofol 3 mg x kg(-1) (Group II; n = 40). The intubating conditions were scored by jaw relaxation, vocal cord position and response to intubation, as well as by blood pressure and heart rate changes. The intubating conditions were good or excellent in 95% of patients in Group I vs 62.5% of patients in Group II (P < 0.05). Blood pressure decreased from a preinduction value of 86 +/- 13 mmHg to 72 +/- 28 mmHg and 74 +/- 19 mmHg in Group I, and from 85 +/- 12 mmHg to 78 +/- 15 mmHg and 78 +/- 12 mmHg in Group II, one and five minutes following intubation (P < 0.05). This drop in blood pressure was not different between the two groups.

Conclusion: An alfentanil-lidocaine-propofol sequence offers significantly better intubating conditions than a fentanyl-lidocaine-propofol sequence in healthy adult patients.