We greatly appreciate the interest that De Melo MS, et al. showed on the
use of remifentanil in a rapid sequence intubation technique that we
recently proposed for patients undergoing surgery during the current
SARS-CoV-2 pandemic [1, 2]. The authors also reported the response
that Tang and Wang wrote to comment on that paper [3]. Given the
interest aroused by our article, we think it would be worth making some
clarifications. In brief, in order to limit aerosolization, we proposed to
systematically perform rapid induction and intubation in the surgical
patient after he had reached a state of deep analgesia with a continuous
infusion of high-dose remifentanil (0.2-0.3 g/kg/min) [2]. Although in
the title of the article this method is labeled as a rapid sequence
induction, in the text, we explain how this technique, far from being
standard rapid sequence intubation, was a rather longer technique in
which the patient, although in a state of profound analgesia and sedation
induced by remifentanil, breathed spontaneously and at last on
command, until hypnosis, and muscle paralysis was rapidly induced with
a low dose of propofol (<0.5 mg/kg) or midazolam (0.05-0.1 mg/kg) and
a full dose of rocuronium (1 mg/kg) [2].
Rapid Sequence Intubation with Remifentanil During COVID-19 Pandemic
