Management of the airway without the use of neuromuscular blocking agents: the use of remifentanil

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Remifentanil belongs to opioid drugs, and its pharmacokinetic characteristics make it unique in this class of drugs and appropriate for use during intubation without neuromuscular blockage. This up-to-date review aims to summarize the findings of recent studies regarding remifentanil and intubation. Remifentanil combined either with propofol or with inhaled anesthetic agents has been proved to provide acceptable intubating conditions. Regarding children patients, remifentanil can be used safely, and as far as intubating conditions are concerned, its effectiveness is as excellent as with neuromuscular blockage. Strong evidence exists that illuminates the usefulness of the drug in cases of difficult airway as well as in neuromuscular diseases. Beyond all these favorable characteristics, anesthesiologists must be conscious with the use of remifentanil.

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