Jsmc-10263

USE OF PROPOFOL AS INTUBATION AID FOR CHILDREN ANESTHETIZED WITH SEVOFLURANE

Sami Waseem Sadeq a, Amanj A. Marouf b and Amir Murad Khudadad b 

a Sulaimani Surgical Teaching Hospital, Kurdistan Region, Iraq.

b College of Medicine, University of Sulaimani, Kurdistan Region, Iraq. 

Submitted: 6/10/2019; Accepted: 13/9/2020; Published: 21/9/2020

DOI Link: https://doi.org/10.17656/jsmc.10263 

ABSTRACT

Background 

Use of muscle relaxants for tracheal intubation in pediatric patients been associated with significant side effects and complications during general anesthesia. Many anesthetic drug combinations have been used to facilitate intubation without the use of relaxants.

Objectives 

To compare the efficacy of three different doses of Propofol to obtain optimum intubating conditions.

Patients and Methods

One hundred and four pediatric patients enrolled in our study after ethical committee approval and written parental consent. Patients were belonging to the American Society of Anesthesiologist physical status classes (I and II), aged from 18 months to 5 years, and were scheduled for tonsillectomy and/or adenoidectomy. Patients were pre-medicated with midazolam 0.2 mg/kg and ketamine 3 mg/kg 15-30 minutes before induction orally. Patients were randomly divided into 4 groups: Group I (control group) did not receive Propofol, while Group II, Group III, and Group IV received (1, 2 and 3 mg/kg of intravenous Propofol respectively). Cough, movement of the limb, tachycardia and smooth intubation condition had been recorded during intubation.

Results

Cough, movement of the limbs, tachycardia were mostly reported among the control group (100%, 74%, 43%) respectively. While smooth intubation condition was mostly among the group IV. 1mg/kg Propofol abolished cough response. 2mg/kg Propofol abolished movement of the limbs. 3 mg/kg Propofol was superior to 2 mg/kg Propofol in decreasing tachycardia response and smooth intubation condition.

Conclusion

Propofol in a dose of 3 mg/Kg I.V. is an excellent adjuvant drug for smooth intubation in children anesthetized with Sevoflurane.

KEYWORDS

Sevoflurane, Propofol, Tracheal Intubation, Pediatric Anesthesia.

References 

1. Butterworth J. F, Mackey D. C, Wasnick  J. D. Pediatric Anesthesia. In: Brian Belval and Harreit Lebowitz, Editors. Morgan & Mikhail’s Clinical Anesthesiology. 5th ed. USA. McGraw-Hill Education LLC; 2013. p. 878-879.

2. Allman K. G, Wilson I. H, D’Onnell A. Paediatric and neonatal Anesthesia. In: Allman K. G, Wilson I. H, Editors. Oxford Handbook of Anesthesia. 3rd ed. UK. Oxford University Press; 2011. p. 811-812.

3. Aitkenhead A.R., Moppett I.K., and Thompson J.P, In: Aitkenhead Editor, Smith and Aitkenhead’s Textbook of Anesthesia. 6th ed. UK. Elsevier Limited; 2013 36:743-744, 2:22-23, 2:14

4. Barash P. G., Cullen B. F., and Stoelting R. K, Clinical Anesthesia, 5th ed. USA. Lippincott Williams & Wilkins; 2006. p. 342.

5. Bricker S. The Anesthesia Science Viva Book. 2nd ed. UK. Cambridge University Press; 2009. p. 203.

6. Miller R.D. and Sdrales L.M.. Miller’s Anesthesia Review. 2nd ed. USA. Saunders, an imprint of Elsevier Inc; 2013. p. 397-398.

7. Marie T, Vanda G, Claude E, Jean J, Sahar M, Roland N. The effect of adjuvant drugs on the quality of tracheal intubation without muscle relaxants in children: a systematic review of randomized trials. Pediatric Anesthesia 2012; 22(7): 616-626.

8. Shaikh, S. I., & Bellagali, V. P. Tracheal intubation without a neuromuscular block in children. Indian Journal of Anaesthesia, 2010; 54 (1), 29–34.

9. Woods AW, Allam S. Tracheal intubation without the use of neuromuscular blocking agents. Br J Anaesth 2005; 94(2): 150–158.

10. Meakin GH. Role of muscle relaxants in pediatric anesthesia. Curr Opin Anaesthesiol 2007; 20(3): 227–231.

11. Simon L, Boucebci KJ, Orliaguet G, Aubineau JV, Devys JM, Dubousset AM . A 6 survey of the practice of tracheal intubation without muscle relaxant in pediatric patients. Pediatric Anesthesia 2002; 12(1): 36–42.

12. Politis GD, Tobin JR, Morell RC, James RL, Cantwell MF. Tracheal intubation of healthy pediatric patients without muscle relaxant: a survey of technique utilization and perceptions of safety. Anesth Analg 1999; 88(4): 737–741.

13. Pellegrini M, Lysakowski C, Dumont L, Borgeat L, Tassonyi E. Propofol 1% versus propofol 2% in children undergoing minor ENT surgery. Br J Anaesth 2003; 90(3): 375–377.

14. Helbo Hansen S, Ravlo O, Trap-Andersen S. The influence of alfentanil on the intubating conditions after priming with vecuronium. Acta Anaesthesiol Scand 1988; 32(1): 41–44.

15. Steyn M, Quinn A, Gillespie J, Miller D, Best C, Morton N.. Tracheal intubation without neuromuscular block in children. Br J Anaesth 1994; 72(4): 403–406.

16. Viby-Mogensen J, Engbaek J, Eriksson LI, Gramstad L, Jensen E, Jensen FS, et al. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40(1): 59–74.

17. Lerman J, Houle T, Matthews B, Houck J, Burrows FA. Propofol for tracheal intubation in children anesthetized with sevoflurane: a dose- response study. Pediatr Anesth 2009; 19(3): 218–224. 

18. Siddik-Sayyid SM, Taha SK, Aouad MT, Abdallah FW, Al Alami AA, Kanazi GE. Propofol 2 mg/kg is superior to propofol 1 mg/kg for tracheal intubation in children during sevoflurane induction. Acta Anaesthesiol Scand 2011; 55(5): 535–538.

19. Kim S. H., Hong J.Y, Suk E. H, Jeong S. M. Optimum bolus dose of Propofol for tracheal intubation during Sevoflurane induction without neuromuscular blockage in children. Anesthesia and Intensive Care, 2011; 39(5): 899-903.

20. Jo YY, Jun NH, Kim EJ, Choi EK, Kil HK. Optimal dose of Propofol for intubation after Sevoflurane inhalation with neuromuscular blocking agent in children. Acta Anaesthesiol Scand. 2011; 55(3):332-6.

21. L. H. Lundstrøm, A. M. Møller, C. Rosenstock, G. Astrup, M. R. Gätke, J. Wetterslev, et al. Avoidance of neuromuscular blocking agents may increase the risk of difficult tracheal intubation: a cohort study of 103 812 consecutive adult patients recorded in the Danish Anaesthesia Database Br. J. Anaesth. 2009; 103 (2): 283-290.

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