Assessment of intubating conditions and haemodynamic responses in children using fentanyl and propofol and its comparison with muscle relaxant technique
European Journal of Molecular & Clinical Medicine,
2022, Volume 9, Issue 2, Pages 1879-1892
AbstractBackground: The present study was undertaken to highlight the benefits of avoiding suxamethonium, using only the opioid-propofol technique for routine intubation in paediatric age groups.
Objective: the advent of shorteracting opioid drugs, intubating the trachea has been particularly successful when these drugs are used in combination with propofol. Propofol has been reported to possess some characteristics that provide adequate conditions for intubation in combination with fentanyl 1,2 or alfentanil 3,4 or remifentanil 5.6.
Material & Method: Sixty children of ASA grade I or II scheduled to undergo elective surgery under general anesthesia were studied. They were randomly divided into two groups of thirty patients each.
Group I: Inj. fentanyl 4 μg.kg-1 and 5 minutes later Inj. propofol 3mg. kg-1 was given.
Group II: Inj. propofol 3 mg. kg-1 followed by Inj. suxamethonium 1mg.kg-1 was given.
Intubation in all cases was done by senior anaesthesiologist, 60 secs after induction with propofol. Intubation scores were recorded according to Helbo-HansenRaulo and Trap-Anderson scoring system. Acceptable intubating conditions (i.e., excellent and good) were observed in 26 (86.7%) out of 30 patients in Fentanyl group. The systolic blood pressure and heart rate, decreased significantly after intubation at 3 and 5 minutes in group Fentanyl when compared with pre-induction values (P<0.001).
Result & Conclusion: Results of present study suggest that in premedicated healthy children administration of fentanyl 4μg.kg-1 in combination with propofol 3mg.kg-1, after adequate waiting period of 6min, reliably provides good to excellent conditions for tracheal intubation and blunts the pressor response to intubation adequately without significant cardiovascular depression. Thus ideal intubating conditions can be achieved without muscle relaxants using fentanyl and propofol and provide an useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided. Refinement of this technique by adjustment of the dose of fentanyl and propofol, and addition of Lignocaine may minimize incidence of coughing and might improve intubating conditions further.
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