Comparison of Intubating Conditions, Following Propofol With Muscle Relaxsant and Profofol Without Muscle Relaxant

Abstract

Introduction: After induction of anaesthesia, tracheal intubation is usually facilitated by the use of muscle relaxants. Neuromuscular blocking drugs, particularly Succinylcholine, may cause serious side effects, but remain in clinical use to facilitate tracheal intubation due to a lack of suitable alternatives. Recent studies have suggested that propofol provides good intubating conditions without muscle relaxants, due to its relaxing action on upper air way. A search for better and ideal intravenous induction agent has led to propofol, a 2, 6, di-isopropyl phenol which was developed following a series of investigations. Propofol reduces hypertension and tachycardia during intubation. The changes in blood pressure observed are due to both decrease in cardiac output and decrease in systemic vascular resistance. Increasing the depth of anaesthesia by administering supplementary increments of induction agent, opioids or lignocaine may improve conditions. These techniques also protect against the potentially adverse effects of tracheal intubation namely systemic, intra-cranial and intra-ocular hypertensions and tachycardia.
 Material and Methods: 50 patients were randomly divided into two groups of 25 patients each. Group I: 2.5 mg/kg body weight of propofol injected slowly over 20 seconds. Group II: 2.5 mg/kg body weight of propofol injected slowly over 20 seconds. After loss of eye lash reflex, induction time was noted with stop watch and then injection succinylcholine 2mg/kg body weight was injected. Patients were monitored throughout the operation E.C.G. using cardiac monitor on lead II, PaO2 with Pulse Oxymeter. Pulse and blood pressure were recorded.
 Results: Youngest patient was of 20 years in group I and 22 years in group II. Eldest patient was of 56 years in group I and 60 years in group II. Maximum number of patients were in 20-30 years of age 15 (60%) in group I and 11 (44%) in group II. Excellent intubating conditions were seen in 15 (60%) patients of group I and 25 (100%) patients of group II. The pre induction mean pulse rate (base line) was 103.04±13.08 and 104.56±17.14 in group I and group II respectively. There was slight decrease in pulse rate initially after induction with mean 99.92±13.87 and 98.32±14.60 in group I and group II respectively, but the difference was not statistically significant from the baseline values. (p>0.05). There was slight decrease in arterial pressure initially after induction with mean 80.88 ±6.59 and 85.31±8.71 in group I and group II respectively, but the difference was not statistically significant (P>0.05) from the baseline values. There was slight increase in mean arterial pressure just after intubation with mean 94.10 ±8.07 and 95.58±9.46 in group I and group II respectively, which was not statistically significant (p>0.05). These changes in M.A.P. values return to baseline values 5 minutes after intubation.
 Conclusion: Propofol 2.5mg/kg when used alone as inducing agent without the aid of any neuromuscular blocking agents produced acceptable intubating conditions, when compared to propofol, 2.5mg/kg along with succinylcholine. It was shown that there were no significant cardiovascular changes when intubation was done without relaxant after induction with propofol.

Rocuronium versus Cisatracurium for Rapid Sequence Induction of Anesthesia in Morbidly Obese Patients

“…Rocuronium bromide 0.9 mg/kg (LBM) IV was given for patient in the first group (R) and Cisatracurium besylate 0.15 mg/kg (LBM) IV was given in the second group (C). Trial of video laryngoscopy was done after suppression 95% of twitch height (Sec), then the intubating conditions was assessed to evaluate the intubation score and this will be done by four-point scale (excellent, good, poor, or inadequate) (10) .…”

“…The excellent scale showed relaxing jaw, abducting immobile vocal cords, and no diaphragmatic movement, but in the good scale there is relaxing jaw, abducting immobile vocal cords, and some diaphragmatic movement (bucking), in the poor scale there is relaxing jaw, moving vocal cords, coughing on intubation, and in an inadequate scale there isn't relaxing jaw, adducting vocal cords, and impossible intubation (10) . When the intubating condition was excellent or good, tracheal intubation was done (Figure : 1) and if it was poor or inadequate (Figure : 2) intubation was postponed and was re-attempted every 30 seconds.…”

“…(Sec). Intubation score was done by 4 points scale: (excellent, good, poor, or inadequate) (10) . Mean arterial blood pressure (MAP) mmHg, heart rate (HR) bpm and oxygen saturation (SpO2) % were recorded at the following intervals: T0, before induction (baseline); T1, after induction and before injection of NMB; T2, after injection of NMB and before endotracheal intubation; T3, just after intubation.…”