Induction of anesthesia and endotracheal intubation in children without muscle relaxant: a comparative study on addition of fentanyl or propofol to sevoflurane

BackgroundIntubation without the need of muscle relaxant is a common practice in pediatric patients. Many drugs are used with inhalational induction to improve the intubation score and to decrease the induction time; of these drugs are propofol and narcotics. The aim of this study was to compare the effect of adding propofol or fentanyl to sevoflurane on the intubating conditions in pediatric patients undergoing adenotonsillectomy.Patients and methodsA randomized controlled study was conducted on 90 patients aged 4-8 years and with ASA physical status I and II scheduled for elective adenotonsillectomy. Patients were divided by opening a sealed envelope into three equal groups, each consisting of 30 patients. Group S patients received inhalational induction alone using sevoflurane. Group SF received 3 mcg/kg fentanyl intravenously followed by inhalational induction using sevoflurane. Group SP received 3 mg/kg propofol intravenously followed by inhalational induction using sevoflurane. The intubation conditions, hemodynamic parameters (heart rate and systolic blood pressure), oxygen saturation, operative time, induction time, and recovery time, were all recorded and statistically analyzed.ResultsWith respect to the intubating condition, no patient in any of the three groups needed rescue muscle relaxant for intubation. Group SP showed more acceptable and excellent intubating conditions compared with the other two groups (90 and 83.3%, respectively). After 6 min, the heart rate was slower, 106.5 (100-110.5) beats/min, and the systolic blood pressure was lower, 110 (110-115) mmHg, in group SF than in the other two groups. Induction time was faster, 107 (99.8-117) min, in group SP than in the other two groups. The recovery time was shorter in group S than in group SF and slightly longer in group SP, with median and interquartile range of 265 (249.5-280) s, 337 (320-360) s, and 500 (496.8-510) s, respectively.ConclusionEndotracheal intubation without neuromuscular blocking agents in pediatric patients undergoing adenotonsillectomy can be achieved with no serious respiratory or hemodynamic adverse events by adding propofol (3 mg/kg) or fentanyl (3 mcg/kg) to sevoflurane. Propofol is suitable for rapid induction as it offers the shortest induction time with 83.3% excellent intubating conditions, whereas fentanyl blunts the stress response to intubation with 46.7% excellent intubating conditions.