Evaluation of endotracheal intubating conditions without the use of muscle relaxants following induction with propofol and sevoflurane in pediatric cleft lip and palate surgeries

Abstract

Background and Aims:Children with facial clefts are usually difficult to intubate and it is considered safer to keep them spontaneously breathing while securing the airway. This prospective comparative study was conducted to evaluate endotracheal intubating conditions in pediatric patients undergoing cleft surgeries, without the use of muscle relaxants following induction with propofol and sevoflurane.Materials and Methods:Sixty patients aged 1month to 3 years, were randomly allocated into two equal groups. Anesthesia was induced with sevoflurane 8% in oxygen in group 1 and with propofol 3 mg/kg in group 2. Laryngoscopy and intubation were attempted 150 s after induction in both groups and ease of laryngoscopy, position of vocal cords, degree of coughing, jaw relaxation, and limb movements were assessed and scored. Total score of 5 was considered excellent, 6-10 good, 11-15 poor, and 16-20 bad. Total score ≤ 10 was considered clinically acceptable, and >10 as clinically unacceptable. Chi-square and Wilcoxon Mann-Whitney tests were used to analyze data.Results:There was no significant difference between groups when ease of laryngoscopy was compared. Sevoflurane induced patients had significantly better position of vocal cords at intubation and the propofol group had significantly more episodes of coughing. Significantly less number of patients had limb movements in sevoflurane group. There was no significant difference in degree of jaw relaxation between groups. The sevoflurane group had significantly better total scores and clinically acceptable intubating conditions.Conclusion:Sevoflurane 8% in oxygen provides clinically acceptable intubating conditions without use of muscle relaxants in pediatric cleft patients.

Acupuncture as an Antiemetic in Children who Underwent Adenoidectomy and/or Tonsillectomy

“…In the literature, it has been demonstrated that a low dose of fentanyl citrate when added to sevoflurane during induction is useful in achieving haemodynamic stability and providing intubation comfort (11,12). Therefore, in this study, fentanyl citrate (1 mcg kg −1 ) was added to 8% sevoflurane during induction.…”

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

“…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].…”

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

“…Until early 1990s, suxamethonium was the only drug for facilitating tracheal intubation due to its rapid-onset and ultra-short duration of action, but it had many potential side effects such as myalgia, elevated intraocular and intracranial pressure, hyperkalemia, masseter spasm, and malignant hyperthermia. [ 1 2 3 4 ] The fatal or near fatal cardiac arrest incidence that occurred in children who received suxamethonium was attributed to hyperkalemia due to undiagnosed muscular dystrophies. [ 5 ] In 1993, United States Food and Drug Administration contraindicated the use of suxamethonium in children and adolescents; however, decision was revoked later but continued to carry a warning cautioning against its use in children.…”

“…Nondepolarizing neuromuscular blocking agents are an alternative but they are slower in onset, have a prolonged neuromuscular blockade, and paralysis cannot be reversed quickly if airway management through mask or tracheal intubation fails. [ 1 3 4 ] Hence, avoiding muscle relaxants when they are not required for planned procedure may prevent complications of their use, misuse, and antagonism. Hence, we sought to provide a method of good intubation conditions rapidly without using muscle relaxants.…”

“…Propofol is found to be the most favorable induction agent due to its profound depressant effect on airway reflexes, pharyngeal and laryngeal activities and muscle tone. [ 4 6 7 8 ] Induction with propofol is quick and smooth with rapid awakening and orientation during recovery. [ 4 ]…”