Tracheal intubation after induction of anaesthesia with propofol, alfentanil and lidocaine without neuromuscular blocking drugs in children

Abstract

In a double-blind study, intubating conditions and haemodynamic responses were assessed in two age-groups of 45 ASA I-II children, with mean ages of 2.4 and 6.3 years, premedicated with oral midazolam and atropine. The children were randomly allocated to one of three groups: alfentanil 20 micrograms.kg-1 + lidocaine 1 mg.kg-1 (Alf20 + Lign); alfentanil 20 micrograms.kg-1 (Alf20); or alfentanil 40 micrograms.kg-1 (Alf40), followed by propofol 3.5 mg.kg-1 in the children aged 1-3 years and 3.0 mg.kg-1 in the older children. Intubating conditions, 40 s after the administration of propofol, were assessed as good, moderate or impossible on the basis of jaw relaxation, ease of insertion of the endotracheal tube and coughing during intubation. In the younger age group the frequencies of good, moderate or impossible intubating conditions were 87, 13 and 0% in the Alf40, 40, 60 and 0% in the Alf20 (P < 0.05 compared to the Alf40 group) and 53, 47 and 0% in the Alf20 + Lign group. In the older age group the corresponding frequencies were 60, 33 and 7% in the Alf20 + Lign, 47, 53 and 0% in the Alf20 and 47, 40 and 13% in the Alf40 group. All the drugs prevented any increase in arterial pressure and heart rate after tracheal intubation. The QTc interval of the ECG was always in the normal range. Clinically important bradycardia did not occur. In conclusion, the best intubating conditions occurred after propofol 3.5 mg.kg-1 and alfentanil 40 micrograms.kg-1 in the younger age group.(ABSTRACT TRUNCATED AT 250 WORDS)

Tracheal intubation after induction of anesthesia in children with propofol — remifentanil or propofol-rocuronium

“…They obviate the need both for succinylcholine with its potential side effects, 1 and for nondepolarizing neuromuscular blocking agents with a duration of action that may be too long in relation to the length of the procedure. The trachea can be successfully intubated after alfentanil-propofol induction sequence in most adult [2][3][4] and pediatric patients 5,6 with normal airway anatomy. However, the dose of alfentanil required to achieve good intubating conditions might have a duration of action that would be too prolonged for short ambulatory surgery procedures.…”

Different small-dose remifentanil blunting the cardiovascular response to laryngoscopy and intubation in children

“…This could be potentially harmful, and avoidance of such circulatory changes during tracheal intubation may be crucial such as in the presence of pulmonary hypertension, cerebrovascular malformation or raised intracranial pressure [2,3]. This adverse cardiovascular response may be attenuated by opioid drugs [4][5][6]. However, most of these drugs are relatively slow in onset and may result in prolonged effects.…”

Propofol zur Intubation bei Säuglingen nach Halothaneinleitung

“…Die Untersuchungen von Donati et al [6,7] [14,27,30,33] bei Kindern und Säuglingen ausgezeichnet bewährt hat, leiteten wir die Narkose inhalativ über eine Maske ein. Der größte Teil der Säug-linge hat vor einem geplanten operativen Eingriff noch keinen venösen Zugang und die Hautbeschaffenheit sowie die kleindimensionierten Venenverhält-nisse bei Säuglingen setzen die Grenzen für die Anwendung der sonst bewähr-ten EMLA-Creme in diesem Alter.…”