Comparative evaluation between sevoflurane and propofol for endotracheal intubation without muscle relaxants in pediatric cleft surgeries

Abstract

Background and Objectives:Endotracheal intubation is the most important and crucial step during administration of general anesthesia. It is more so in pediatric patients with associated deformities of cleft lip, palate, and alveolus. Propofol, an intravenous (i.v.) induction agent, has profound depressant effect on airway reflexes with a quick and smoother induction. Similarly, sevoflurane, an inhalational agent, has relatively pleasant smell, low airway irritability, and more cardiostable properties. Hence, we sought to compare effectiveness of propofol with sevoflurane in achieving good intubation conditions without the use of muscle relaxants.Materials and Methods:In this prospective randomized study, eighty children belonging to American Society of Anesthesiologist physical status Class I and II, aged 1–10 years, scheduled for cleft surgery were included. All participants were premedicated. Patients were allotted to Group A and Group B randomly. Group A received propofol and Group B received sevoflurane as induction agents. Tracheal intubation was attempted in all patients at 150 s. Intubation conditions were assessed by using Steyn modification of Helbo–Hansen intubating conditions score. Statistical analysis was done using Student's t-test and Chi-square test with P < 0.05 regarded as significant.Results:Group B patients receiving sevoflurane had significantly more clinically acceptable intubation conditions than patients of Group A receiving i.v. propofol (P = 0.001).Conclusion:We conclude that intubation conditions using inhalational 8% sevoflurane are superior to i.v. propofol of 3 mg/kg for tracheal intubation without muscle relaxants in children undergoing cleft surgeries.

Anesthetic Management for Dental Procedures of a Child with Frank-ter Haar Syndrome

“…However, they have slow onset, prolonged duration of action and prolonged reversing periods of their effects during failed intubation and airway management with mask ventilation and are associated with pulmonary complications of reversal agents. 11 The short-acting opioid remifentanil and propofol were chosen for their effectiveness in suppressing airway reflexes, and muscle relaxants were not used in intratracheal intubation. The same was applied in Tommasino and Albicini's case.…”

Anesthesia Considerations in the Perioperative of Patients with Lip and Palate Length

“…The one made with propofol is characterized by being fast and smooth with the additional advantage of a rapid awakening; in the inhalation with sevofluorane, the advantages lie in halogenated characteristics such as the unpleasant smell, the less irritation of the respiratory tract, the lower solubility in the blood and, in a secondary way, the lower myocardial depression. Other intravenous inducers such as thiopental, midazolam, and ketamine are mentioned in the literature [3,22].…”

“…It is important to use a technique that provides us with rapid and safe favorable intubation conditions in an adequate time. Some authors evaluate the conditions of intubation through the Helbo-Hansen scale that emerged in 1988, which assesses aspects such as jaw relaxation (complete, tone, tense, or rigid), laryngoscopy (easy, good, difficult, or impossible), vocal cords (open, moving, closing, or closing), cough (absent, poor, moderate, or severe), and limb movements (absent, scarce, moderate, or severe); scores of 1-2 indicate favorable conditions, while scores of 3-4 are unacceptable [21,22].…”

“…There is sufficient evidence that positions propofol as a favorable inducing agent by decreasing airway reflexes and providing adequate conditions for intubation without muscle relaxants; sevofluorane at 8 volume percent facilitates the proper position of the vocal cords in the absence of muscle relaxants, in a period of 180 seconds with low incidence of cough [22].…”

“…The use of neuromuscular blockers is controversial. It is a fact that they provide favorable conditions for endotracheal intubation, and according to literature reports, there is a lower incidence of respiratory adverse events when they are used; succinylcholine with rapid onset of action and ultra-short effect but with a risk of adverse effects in the pediatric population positions rocuronium and vecuronium non-depolarizing neuromuscular blockers as an alternative with a slower onset, prolonged effect, and great advantage of pharmacological reversal of rocuronium in a situation of unexpected difficult airway [3,22]. In contrast, some authors recommend avoiding them due to the high incidence of retrognathia, micrognathia, and glossoptosis that make it difficult to approach the airway from ventilation with a facial mask, laryngoscopy, or endotracheal intubation, emphasizing the existence of other alternatives that offer favorable conditions of intubation such as those mentioned [22,23].…”