Comparative evaluation of alfentanil with propofol or sevoflurane for endotracheal intubation in pediatric without muscle relaxant

ABSTRACT

Intubation without muscle relaxant may be needed especially in pedi-atric short procedure. Although suxamethonium produces rapid profound neuromuscular block, it have many potential problems. Non-depolarizing neuromuscular blocking agents are an alternative but, slower in onset and have a longer duration of action. Propofol and sevoflurane may provide adequate conditions for intubation without neuromuscular blocking agents in pediatric. We studied 60 ASA I or II children undergoing elective surgery. Patients allocated randomly to one of two groups. Group P [GP] received lignocaine 1mg kg[-1] followed by alfentanil 15micro kg[-1] 2 min before propofol 2.5 mg kg[-1] was given. In group S [GS] patients received lignocaine Img kg[-1] followed by alfentanil 15 microg kg[-1] and induction of anesthesia was done by sevoflurane start by 3% concentration, which increase gradually until end tidal concentration was 3%, Laryngoscopy and intubation was performed, in GP 1 min after propofol and in GS 3min after stabilization of end tidal sevoflurane to 3%. Intubation conditions were assessed and recorded. Duration of induction and intubation were estimated. Complications during induction, intubation, and after extubation were recorded. Patients with acceptable intubation conditions in GP were more by one than GS group, but these results were statistically not significant and unacceptable condition was equal in both groups, impossible intubation conditions happened only in one patient in GS. Induction time was significantly prolonged in GS, but intubation time did not show significant difference between both groups. Adverse effects, hypertension was occurred in one patient in GS. Hypotension and bradycardia were happened in one patient in GP. Only one patient, in GS, expressed laryngospasm and hypoxia which need suxamethonium to facilitate intubation. After extubation. laryngospasm and vomiting occurred in 1 and 2 patients in GS respectively and no patient in GP suffer from vomiting or laryngospasm. We concluded that, Induction with intravenous propofol or inhalational sevoflurane, in addition to intravenous alfentanil and lignocaine equally facilitate endotracheal intubation without muscle relaxant in pediatric patients. Induction time was significantly prolonged with sevoflurane bat intubation time, show; no significant difference