The effect of different doses of propofol on tracheal intubating conditions without muscle relaxant in children

Abstract

Propofol (3.0 mg kg(-1)) preceded by fentanyl (3.0 microg kg(-1)) was adequate for the induction of anaesthesia in children and provided adequate tracheal intubating conditions without significant haemodynamic changes. This method represents a useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided.

Assessment of Intubating Conditions with Different Doses of Propofol without Muscle Relaxant in Children

“…Intubating conditions were found acceptable in 97.5% of patients in group II (propofol 3.0 mg/kg) and 100% in group III (propofol 3.5 mg/kg) with no statistically significant difference between the two groups. De Fatima et al [5] with the same dose combination, found acceptable intubating conditions in 20%, 75%, and 80% of patients in each group. However, they used only three criteria for assessing the intubating conditions: (i) the degree of difficulty in laryngoscopy; (ii) intensity of coughing; (iii) and the presence of vocal cord movement.…”

“…Klemola et al [10] also found a 12% fall in MAP and 8% fall in HR with a dose combination of 4.0 mg/kg remifentanil and 3.5 mg/kg propofol, while de Fatima et al [5] did not find any significant changes in hemodynamics. This fall in cardiac output may not be well tolerated in high-risk patients, where it could become significant.…”

“…Propofol, one of the most frequently used induction agent, has favorable depressant effect on the pharyngeal and laryngeal reflexes [12] and the muscle tone [13,14]. The induction with propofol is quick and smooth, with rapid awakening during recovery [15].With the adjuvant of shortacting opioids, their use in combination with propofol for tracheal intubation without neuromuscular blocking agents has been well documented [1,[4][5][6]. Numerous studies have stressed the advantages of propofol, such as a low cumulative effect which offers fast recovery of consciousness after surgery, an antiemetic effect, a diminished pressor response to laryngoscopy and tracheal intubation, and a lower incidence of airway complications, in adults and pediatric patients [16,17].…”

“…Several workers have successfully used a combination of propofol and a short-acting opioid to facilitate tracheal intubation in children [1,[4][5][6]. Most of the studies revealed improvement in intubating conditions with increasing dosages of either propofol [5] or opioid [1].…”

“…Most of the studies revealed improvement in intubating conditions with increasing dosages of either propofol [5] or opioid [1]. Increasing dose of short-acting opioids may cause muscle rigidity, prolonged apnea and delayed recovery, while increasing dose of propofol can lead to cardiovascular depression.…”