Intubation without Muscle Relaxant: Comparison of Propofol –Fentanyl or Propofol – Halothane anaesthesia in children

Abstract

Objective: To determine the feasibility of intubation, intubating conditions and variations in haemodynamic parameters in children where neuromuscular blockade is omitted.
Method: 120 children aged 3-12 years, ASA I&II undergoing elective surgery under general anaesthesia with endotracheal intubation were selected and divided into 3 groups according to the technique of intubation. Patients in Group I were induced with injection(inj.) fentanyl 2μg/kg and inj.Propofol 2.5 mg/kg and intubation attempted while patients in Group II were induced with incremental concentration of halothane to achieve end tidal concentration of 1 % followed by inj.propofol 2.5 mg/kg and intubation attempted. Inj Thiopentone 5 mg/kg and Inj Succinylcholine 2mg/kg were administered to patients in Group III. Intubating conditions were assessed using scoring system of Hensen Helbo.
Results: Intubation was successful in 31/40 patients(77.50%) in Group I, 36/40(90%) in Group II, and 40/40(100%) in Group III respectively. 25 patients in Group I were intubated at the first attempt while six needed a second attempt. 33 patients in Group II were intubated at the first attempt while 3 patients needed a second attempt. All patients were intubated at the first attempt in Group III.
Conclusion: Alternative techniques of intubation are feasible in those children with favourable anatomy and may be tried where neuromuscular blockade needs to be avoided.

Key words: Technique: Endotracheal intubation, Intubating condition, alternate technique.