ASSESSMENT OF INTUBATING CONDITIONS AND HAEMODYNAMIC RESPONSES IN CHILDREN USING FENTANYL AND PROPOFOL AND ITS COMPARISON WITH MUSCLE RELAXANT TECHNIQUE.

Shaswat Pattnaik; Daisy Karan; Sudeep Mohapatra

Volume : IX, Issue : V, May - 2019

ASSESSMENT OF INTUBATING CONDITIONS AND HAEMODYNAMIC RESPONSES IN CHILDREN USING FENTANYL AND PROPOFOL AND ITS COMPARISON WITH MUSCLE RELAXANT TECHNIQUE.

Shaswat Pattnaik, Daisy Karan, Sudeep Mohapatra

Abstract :

Background: Endotracheal intubation is frequently facilitated by administration of a depolarizing muscle relaxant such as suxamethonium during induction of anaesthesia with short–acting hypnotic drugs. However, suxamethonium administration may be associated with side effects such as postoperative myalgia, prolonged paralysis, increase in intraocular pressure and hyperkalaemia1 .Routine use of suxamethonium for tracheal intubation in children is being criticized following some reportsof cardiac arrest and death in young children. For these reasons,a method of providing good intubating conditions rapidly without using muscle relaxants has been sought by a number of investigators. Aim & Objective: The purpose of the present study will be to assessintubating conditions and haemodynamic responsesin children after induction of anaesthesia usingfentanyl–propofol and to compare the results with those obtained with a propofol–suxamethonium induction sequence. Material & Methods: This is a prospective study , conducted during (2017–2018) in our institute. 60 patients aged between 4–12yrs, ASA–I &ASA–II belonging to either sex were included in the study.The children who were posted to undergo various elective surgical procedures, for which endotracheal anaesthesia will be planned,were selected.Children with suspected difficult intubation,ASA physical status 3 or 4, havinghistory of allergy to any of the study drugs, undergoing ophthalmic and neurosurgical operations were excluded from study. Patients were randomly grouped into 2 groups of 30 each GROUP– F:Inj. fentanyl 4 μg/kg + Inj. propofol 3 mg/kg GROUP– S:Inj. propofol 3 mg/kg + Inj. suxamethonium 1 mg/kg. The quality of intubation will be graded by using the scoring system devised by Helbo–HansenRaulo and Trap–Anderson. Four variables were assessed • Ease of laryngoscopy • Position of vocal cords • Degree of coughing • Jaw relaxation Measurements of heart rate, systolic arterial pressure and arterial O2 saturation were noted at different time intervals (pre–induction, post–induction, postintubationat 0, 1, 3 and 5 minutes) Measurements at 1 minute after injection of atropine were taken as baseline values.Balanced anaesthesia was maintained subsequently as necessary for each case. Results: Results of present study showed that tracheal intubation was successful in 86.7% of children receiving fentanyl 4 μg.kg–1– propofol 3 mg.kg–1 and 100% of patients receiving propofol3 mg.kg–1 –suxamethonium 1 mg.kg–1. Only 4 out of 30 patients had unacceptable intubating conditions in the fentanyl–propofol group. Conclusion: Ideal intubating conditions can be achieved without muscle relaxants using fentanyl and propofol and provide an useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided.