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TRACHEAL INTUBATION IN CHILDREN: A COMPARISON OF SEVOFLURANE VERSUS PROPOFOL-SUXAMETHONIUM
Abstract
Inhalational induction and tracheal intubation without muscle relaxant has been shown to be suitable for tracheal intubation in children. Sevoflurane and a potent opioid have been reported to provide excellent conditions for endotracheal intubation in children.
Sevoflurane is a relatively new volatile agent that was recently available in National Hospital, Abuja and it has been shown to have a sweet smell, low airway irritability, low blood gas solubility and thus rapid induction. It is also known to provide acceptable clinical intubation conditions comparable to propofol- suxamethonium which is thought to provide optimal conditions for tracheal intubation in children. It was hypothesized therefore that inhalational induction and intubation with sevoflurane in nitrous oxide and oxygen will provide acceptable clinical conditions for tracheal intubation.
This is a prospective, randomized, double-blinded study performed in children aged 3 to 10 years. It was carried out at the National Hospital, Abuja. Following institutional Research and Ethics Committee approval, a total of 66 children were recruited, drawn from paediatric patients scheduled for different types of surgeries lasting less than 90 minutes. Patients were randomized by using opaque sealed envelopes containing sequential randomized numbers in to two equal groups. Group I received intravenous propofol 2.5mg/kg and intravenous suxamethonium 1.5mg/kg while group II had inhalational induction with sevoflurane in nitrous oxide and oxygen incrementally from 1.5% (increased after every 3 breaths by 1.5%) up to a maximum of 8% until the patients reached clinical end- point for intubation. The investigator anaesthetist performed the endotracheal intubation and the intubating conditions were graded using the Helbo-Hanson Scoring system. Data analysis was done using SPSS (Statistical Package for the Social Sciences) version 18, statistical significance was set at P<0.05.
There was no statistically significant difference in the socio-demographic characteristics between the two groups. The baseline and intraoperative vital signs of heart rate, blood pressure and SPO2 were also comparable in both groups.
The mean time taken from induction to laryngoscopy was 91.27s±29.96s in group I and 219.09±63.85s in group II and mean time taken from induction to completion of intubation was 120.3±34.13s and 247.18±64.66s respectively in both groups with a P value of <0.05 which was highly statistically significant. However, the time taken from laryngoscopy to completion of intubation between the groups was not statistically significant (P=0.05).
The intubation score using Helbo-Hanson Scoring System revealed that 84.8% scored 4, 15.2% scored 5 and no patient scored 6 in group I whereas 45.5% scored 4, 48.5% scored 5 and 6.1% scored 6 in group II with a P value of <0.05 which was statistically significant. Although, group II patients had higher scores but the scores were still within clinically acceptable intubation condition.
Immediate post intubation, the heart rate, systolic blood pressure and temperature were comparable in both groups. The diastolic blood pressure at 1, 3 and 5 minutes post intubation as well as the mean arterial pressure (MAP) at 1 and 5 minutes had P values of <0.05 which were statistically significant.
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Immediate post induction and intubation side effects were minimal in both groups except for pain on injection in 21.2% in group I and 6.1% had laryngospasm in group II. Postoperative side effects which included postoperative nausea/retching/vomiting, 24 hours postoperative sore throats with a P value of <0.05 were not statistically significant between the two groups. Postoperative agitation was observed in 9.1% of patients in group I and 33.3% of patients in group II with a P value of <0.05 which was statistically significant.
Parental/guardian satisfaction with anaesthesia was similar in groups I and II as both groups expressed good satisfaction with anaesthesia with a P value of >0.05 which was not statistically significant.
This study showed that acceptable clinical condition for intubation was demonstrated in both groups and sevoflurane could provide alternative and successful conditions for intubation in children especially when a muscle relaxant is unnecessary or contraindicated.
