A survey of practice of tracheal intubation without muscle relaxant in paediatric patients

• Published in: Pediatric anesthesia Vol. 12; no. 1; pp. 36 - 42
• Main Authors: SIMON, LIONEL, BOUCEBCI, KARIM J, ORLIAGUET, GILLES, AUBINEAU, JEAN-VINCENT, DEVYS, JEAN-MICHEL, DUBOUSSET, ANNE-MARIE
• Format: Journal Article
• Language: English
• Published: Oxford UK Blackwell Science Ltd 01.01.2002
• Subjects: Adolescent; Anesthesia, General; Anesthetics, Inhalation; Anesthetics, Intravenous; Child; Child, Preschool; children; Data Collection; Humans; Infant; Intubation, Intratracheal; Methyl Ethers; Muscle Relaxants, Central; Propofol; sevoflurane; Surveys and Questionnaires; tracheal intubation
• ISSN: 1155-5645; 1460-9592
• DOI: 10.1046/j.1460-9592.2002.00727.x

Background: Because of the renewed interest in intubation in children without relaxants, over a period of 1 month, the anaesthesiologists of five paediatric universitary teaching hospitals were asked to complete a questionnaire each time they performed a tracheal intubation without muscle relaxant. Methods: Intubating conditions were assessed with five items. Each item was graded on a four‐point scale. Intubating conditions were judged acceptable when all items scored 2 or less. Episodes of oxygen desaturation and failed intubations were noted. Data are expressed as mean ± SD (extremes). Results: Five hundred and two questionnaires were completed during the study period. Children were aged 61 ± 50 (1–180) months old. Induction of anaesthesia was performed with sevoflurane for 62.6% of the children (endtidal concentration 5.9 ± 1.5%) and propofol for 28.9% (dose 5.8 ± 4.2 mg·kg–1). Opioids were associated with these hypnotics in 53.2% of the children. Tracheal intubation was successful in 87.1% of the children. Sevoflurane produced better intubating conditions than propofol. Sevoflurane requirements for tracheal intubation may be higher in infants aged less than 6 months old than in older children. A severe decrease in SpO2 (≤ 90%) was observed in 15.9% of the infants aged less than 1 year old and in 1.7% of the children, respectively (P < 0.0001). Conclusions: Sevoflurane is the most commonly used agent for tracheal intubation without relaxants with higher doses being required in infants aged less than 6 months. Propofol, even with opioids, was not so successful.