Rapid Sequence Intubation with Remifentanil During COVID-19 Pandemic

Rapid Sequence Intubation with Remifentanil During COVID-19 Pandemic

Author Info

Corresponding Author
Sergio Bevilacqua
Department of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy


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].

Article Info

Article Type
Letter to the Editor
Publication history
Received: Mon 04, Jan 2021
Accepted: Tue 19, Jan 2021
Published: Fri 29, Jan 2021
© 2023 Sergio Bevilacqua. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.ACR.2021.01.01