Endotracheal Intubation Using Propofol, Midazolam, Lignocaine Induction Along With Fentanyl in Two Different Doses; Without Using Neuromuscular Blocking Drugs: A Comparative Randomised Prospective Study

Abstract

BACKGROUND:The standard techniques of tracheal intubation are usually done after induction of anaesthesia followed by skeletal muscle relaxation. The muscle relaxants are associated with many side effects. These side effects have spurred research into development of alternative methods for providing good intubating conditions. AIMS AND OBJECTIVES: Present study is designed to compare the intubating conditions, hemodynamic changes following two different doses of fentanyl (2 and 3mcg/kg) using midazolam, lignocaine and propofol induction. MATERIALS AND METHOD: A prospective randomized study was carried out in the department of Anaesthesia at Rajarajeswari Medical College and Hospital. The patients of either sex and age group between 18 and 60years belonging to ASA I and II scheduled for operation under general anaesthesia in various surgical departments for elective surgery were subjects of our study. Patients were randomly divided into two groups of 50 patients each. Group-I received Midazolam (0.04mg/kg), study drug Fentanyl (2mcg/kg), Lignocaine (1.5mg/kg) and propofol (2mg/kg). Group-II received Midazolam (0.04mg/kg), study drug Fentanyl (3mcg/kg), Lignocaine (1.5mg/kg) and propofol (2mg/kg). STATISTICAL ANALYSIS: To assess the intubating conditions Statistical test used was chi square test and software used was SPSS version 10. The power we achieved for response to intubation is 0.95. To assess the hemodynamic effects Statistical test used was paired t test within the group and student t test between the groups and software used was SPSS version 10. The power we achieved for pulse rate and mean BP is 0.81 and 0.93 respectively. RESULTS AND CONCLUSION: showed that fentanyl 3mcg/kg with propofol, midazolam and lignocaine provides better intubating conditions and effective in blunting hemodynamic responses to intubation when compared to fentanyl 2mcg/kg. Fentanyl 3mcg/kg with propofol, midazolam and lignocaine combination represents a useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided.