Title: Awake intubation using the GlideScope® video laryngoscope: initial experience in four cases
Abstract: thetic room, a venipuncture was performed using a 22-gauge catheter without local anesthetic skin infiltration.This was flushed with 2 mL of normal saline.Children in Group I received remifentanil 0.25 µg•kg -1 (diluted with normal saline to 5 mL) over 30 sec followed 60 sec later by propofol.Group II received remifentanil 0.5 µg•kg -1 (diluted with normal saline to 5 mL) over 30 sec followed 60 sec later by propofol.The propofol (3 mg•kg -1 ) was injected over 20 sec and a blinded observer noted propofol pain on the four-point behavioural pain scale proposed by Cameron et al.: 3 0 = no pain; 1 = mild pain (grimace); 2 = moderate pain (grimace + cry); and 3 = severe pain (cry + withdrawl).The injection was performed manually by one of the investigators who gauged the speed of injection from the wall-mounted clock.The incidence of pain was 60% in Group I compared with 23.5% in Group II (P < 0.001).Moderate and severe pain occurred in 22% and 14% respectively of patients in Group I, compared to 11.7% and 1.9% in Group II (P < 0.001).These results indicate that remifentanil pretreatment (0.5 µg•kg -1 ) 60 sec before propofol administration significantly reduces pain associated with propofol injection in children compared to remifentanil 0.25 µg•kg -1 .The site of action of remifentanil in reducing pain may be either central or peripheral.The dose we used is low and is lower than the dose which one would choose if one wanted a central analgesic effect.Opioid receptors are present at peripheral sensory nerve terminals in humans.Remifentanil has a selective agonist action at µ opioid receptors. 4 It is possible that the reduction in injection pain was the result of a peripheral action.