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Updated: Feb 8, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Comparative Evaluation between Sevoflurane and Propofol for Endotracheal Intubation without Muscle Relaxants in
Harish Karanth1, U S Raveendra2, Rithesh B Shetty1
1Department of Anaesthesiology, A J Institute of Medical Sciences, Mangalore, Karnataka, India.
Insights
Sevoflurane provides superior tracheal intubation conditions compared to propofol in pediatric cleft surgery patients. This study found inhalational sevoflurane to be more effective than intravenous propofol for intubation without muscle relaxants.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Airway Management
Background:
- Endotracheal intubation is critical in pediatric anesthesia, especially for patients with cleft lip/palate deformities.
- Propofol offers rapid induction but can depress airway reflexes.
- Sevoflurane provides a smoother induction with less airway irritability.
Purpose of the Study:
- To compare the effectiveness of propofol versus sevoflurane for achieving optimal endotracheal intubation conditions.
- To evaluate intubating conditions without the use of muscle relaxants in pediatric cleft surgery patients.
Main Methods:
- A prospective randomized study included 80 pediatric patients (1-10 years) with ASA physical status I/II undergoing cleft surgery.
- Patients received either intravenous propofol or inhalational sevoflurane for induction.
- Intubation conditions were assessed using the Steyn modification of the Helbo-Hansen score.
Main Results:
- Sevoflurane group (Group B) demonstrated significantly better clinically acceptable intubation conditions compared to the propofol group (Group A).
- The difference in intubation conditions between the two groups was statistically significant (P = 0.001).
Conclusions:
- Inhalational sevoflurane (8%) provides superior tracheal intubation conditions compared to intravenous propofol (3 mg/kg).
- Sevoflurane is a preferable induction agent for facilitating muscle-relaxant-free tracheal intubation in pediatric cleft surgery.
Background And Objectives:
Endotracheal intubation is the most important and crucial step during administration of general anesthesia. It is more so in pediatric patients with associated deformities of cleft lip, palate, and alveolus. Propofol, an intravenous (i.v.) induction agent, has profound depressant effect on airway reflexes with a quick and smoother induction. Similarly, sevoflurane, an inhalational agent, has relatively pleasant smell, low airway irritability, and more cardiostable properties. Hence, we sought to compare effectiveness of propofol with sevoflurane in achieving good intubation conditions without the use of muscle relaxants.
Materials And Methods:
In this prospective randomized study, eighty children belonging to American Society of Anesthesiologist physical status Class I and II, aged 1-10 years, scheduled for cleft surgery were included. All participants were premedicated. Patients were allotted to Group A and Group B randomly. Group A received propofol and Group B received sevoflurane as induction agents. Tracheal intubation was attempted in all patients at 150 s. Intubation conditions were assessed by using Steyn modification of Helbo-Hansen intubating conditions score. Statistical analysis was done using Student's t-test and Chi-square test with P < 0.05 regarded as significant.
Results:
Group B patients receiving sevoflurane had significantly more clinically acceptable intubation conditions than patients of Group A receiving i.v. propofol (P = 0.001).
Conclusion:
We conclude that intubation conditions using inhalational 8% sevoflurane are superior to i.v. propofol of 3 mg/kg for tracheal intubation without muscle relaxants in children undergoing cleft surgeries.
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