The optimal pediatric induction dose of propofol in combination with reduced-dose rocuronium and alfentanil for day-case tonsillectomy in children

Bartolek, Dubravka; Lajtman, Z; Zdravčević-Šakić, Kata; Jakobović, Jasminka; Bartolek, Franjo; Cavrić, Gordana

doi:10.1016/j.ijporl.2007.08.016

Cited by 9 publications

(6 citation statements)

References 33 publications

(38 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results mirrored those of Bartolek et al 17 were not statistically significant although up to a 15% reduction in systolic pressure was noted in some patients. A similar decrease in MAP (12%) was found in the study by Bartolek et al 17 Lerman et al 12 found a dose dependent increase in the incidence of apnoea. The incidence of apnoea was 21% with 0 mg/kg; 25% with 0.5 mg/kg; 38% with 1 mg/kg; 45% with 2 mg/kg and increased to 80% with 3 mg/kg.…”

Section: Discussionsupporting

confidence: 90%

Intubating conditions following four different doses of propofol in children

Preez

Dippenaar

2020

Southern African Journal of Anaesthesia and Analgesia

View full text Add to dashboard Cite

Background: Day case surgery offers advantages to the patient, the family and the performing institution. Children are excellent candidates since they are generally healthy and often require brief surgical interventions. Day case surgery requires rapid emergence from anaesthesia, minimal delay in recovery and rapid readiness for discharge from the ward. The ideal anaesthetic agents should have rapid onset, short duration, minimal side effects and minimal residual effects. The pharmacodynamics and -kinetics of propofol and alfentanil are well suited for day case surgery and may obviate the need for muscle relaxants. The purpose of our study was to determine the optimal dosing schedules for intubation following propofol combined with alfentanil and sevoflurane anaesthesia while maintaining haemodynamic stability as these dosing schedules still warrant refinement. Methods: We conducted a randomised prospective blinded study in which fifty-nine children (aged 3–10 years) presenting for dental extractions were induced with sevoflurane (in 50% oxygen/nitrous oxide), then received propofol (0.5, 1, 1.5 or 2 mg/kg) and alfentanil (10 μg/kg) to aid intubation. For each dose of propofol, the ease of intubation (assessed by the Helbo-Hansen score) was correlated with blood pressure and pulse rate (prior, during and after intubation) to determine the optimal propofol dosage allowing adequate intubation conditions with the least haemodynamic effects. Results: Overall adequacy of intubating conditions improved significantly (p = 0.0079) as propofol dose increased. Similarly, decrease in vocal cord movement (p = 0.0341), incidence of coughing (p = 0.0379) and limb movement (p = 0.0165) was observed. Ease of laryngoscopy and jaw relaxation did not improve significantly (p = 0.1319 and 0.1971 respectively). Changes in systolic, diastolic and mean arterial pressure as propofol dose increased were not statistically significant. Conclusion: Propofol in a dose of 1.5 to 2 mg/kg (when used in conjunction with alfentanil 10 μg/kg, after sevoflurane induction) allowed adequate intubating conditions whilst maintaining cardiovascular stability. The decrease in blood pressure, although not statistically significant, may become clinically relevant in children with underlying cardiovascular disease. This drug combination seems to be a reasonable means for avoiding the need for muscle relaxation for children who require tracheal intubation for brief surgical procedures.

show abstract

Section: Discussionsupporting

confidence: 90%

Intubating conditions following four different doses of propofol in children

Preez

Dippenaar

2020

Southern African Journal of Anaesthesia and Analgesia

View full text Add to dashboard Cite

show abstract

“…General anesthesia with rocuronium (0.45 mg/kg) in infants revealed good results such as effect time, satisfaction of intubation, and time of restoration, 14,15 and was suitable for short operation. 16 The achieved tracheal intubation time observed in our study was 90-120 s without applying topical lidocaine on the pharynx. The dose of rocuronium (0.45 mg/kg) used in our study was determined to ensure a short onset time that was sufficient for clinical duration time for surgery and to avoid prolonged muscle relaxation.…”

mentioning

confidence: 52%

Anesthesia with propofol‐remifentanil combined with rocuronium for bronchial foreign body removal in children: Experience of 2 886 cases

Qiu

et al. 2018

Pediatric Investigation

View full text Add to dashboard Cite

Importance: The appropriate anesthetic method can reduce the complications of children with tracheal foreign body and reduce the mortality rate of children. What kind of anesthetic method to choose has always been the focus of debate. Purpose: To evaluate the efficacy and safety of anesthesia with propofolremifentanil combined with rocuronium for foreign body aspiration (FBA) removal with the positive-pressure ventilation technique. Methods: Medical records of patients who underwent bronchoscopy for evaluation of FBA in our unit from January 2015 to January 2018 were retrospectively reviewed. Demographic data (age and sex), nature of foreign body and location, complications, length of hospital stay and outcome were analyzed. Results: A total of 2 886 children were included in this study. The median age was 24 months (8 months to 10 years). FBA was detected and removed in 95.6% of patients. The average operation time was 17 ± 5 min and average length of hospital stay was 2 days. Observed peri-interventional complications included desaturation (n = 66), laryngospasm (n = 19), laryngeal or subglottic edema (n = 15), irritating cough (n = 3), body movement (n = 76) and pneumonia (n = 206). No deaths occurred during hospitalization or follow-up in this series. Interpretation: Anesthesia with propofol-remifentanil combined with rocuronium under positive-pressure ventilation is an effective and safe technique during FBA removal in children.

show abstract

“…Collins and Klemola has shown that induction dose of propofol (2.5–3.5 mg·kg −1 ) with alfentanil (20 μg·kg −1 ) or remifentanil (4 μg·kg −1 ) gives also acceptable (excellent and good) intubating condition in children when NMB drugs are not used (2,15). Low‐dose rocuronium (0.4 mg·kg −1 ) in addition with propofol and alfentanil/remifentanil anesthesia induction my improve the most excellent intubating conditions without significant hemodynamic changes and prolonged postanesthesia recovery (6,10). Following this, waiting for maximal depression of twitch for intubation is not required in every day practice.…”

Section: Discussionmentioning

confidence: 99%

“…Rocuronium bromide is an intermediate‐acting NMB drug with short onset time of neuromuscular block (5,6). Reduced‐dose of rocuronium bromide has been tested on pharmacodynamics and intubating conditions in different ways as reported by many authors (7–10). Perioperative time saving is still the matter of interest for day‐case tonsillectomy in children where reduced‐dose rocuronium is used.…”

Section: Introductionmentioning

confidence: 99%