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Published on: January 17, 2011
A Comparative Study between Propofol-fentanyl versus Propofol-suxamethonium for Ease of Endotracheal Intubation in
Alfa Mikailu1, Mamuda Atiku1, Ahmad Abdurrahman1
1Department of Anaesthesia, Aminu Kano Teaching Hospital, Kano, Nigeria.
Insights
Suxamethonium provides superior intubating conditions in children compared to fentanyl when used with propofol. However, propofol-fentanyl is a viable alternative for pediatric tracheal intubation when suxamethonium is contraindicated.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacology
Background:
- Suxamethonium is the standard for improving pediatric intubation conditions after propofol induction.
- Contraindications exist for suxamethonium, necessitating alternative agents.
- Fentanyl has shown variable results as a suxamethonium alternative.
Purpose of the Study:
- To compare the ease of tracheal intubation using propofol-suxamethonium versus propofol-fentanyl in children.
- To evaluate intubating conditions in pediatric patients under general anesthesia.
Main Methods:
- A double-blind, randomized controlled trial involving 84 pediatric patients (ASA I or II).
- Patients received either propofol-suxamethonium (1.5 mg/kg) or propofol-fentanyl (3 mcg/kg) for induction.
- Intubating conditions were assessed using a modified Helbo-Hansen's score two minutes post-induction.
Main Results:
- All intubations were successful on the first attempt in both groups.
- Suxamethonium group showed significantly better overall intubating conditions (p=0.0001).
- Excellent intubation conditions were achieved in 85.7% of the suxamethonium group versus 21.4% in the fentanyl group.
Conclusions:
- Propofol-fentanyl offers a viable alternative to propofol-suxamethonium for facilitating pediatric tracheal intubation.
- This finding is crucial for cases where suxamethonium is contraindicated.
Background:
Following propofol induction, suxamethonium tremendously improves intubating conditions in children and has been the gold standard agent for this purpose. However, suxamethonium could be absolutely contraindicated in some patients. Fentanyl, a short acting opioid, has been investigated as a suitable alternative with varying results.
Aim And Objectives:
This study compares the ease of tracheal intubation between propofol-suxamethonium (1.5 mg/kg) and propofol-fentanyl (3 mcg/kg) during general anaesthesia among children.
Patients And Methods:
In this double-blind randomised controlled study, 84 ASA I or II patients booked for elective surgery under general anaesthesia requiring tracheal intubation were randomised into two groups (F and S). Induction was with propofol 3 mg/kg over 30 s followed by either fentanyl 3 mcg/kg or suxamethonium 1.5 mg/kg. Two minutes later, there was an attempt at intubation and intubating conditions were assessed using Steyn's modification of Helbo-Hansen's score (ease of laryngoscopy, jaw relaxation, coughing, vocal cord position, and limb movement).
Results:
All patients in both groups had successful intubation at the first attempt. Patients in group S (suxamethonium) had significantly better overall intubating conditions compared to those in group F (fentanyl) (p=0.0001), 85.7% in group S compared to 21.4% in group F had excellent intubation condition. None of the patients in the two groups demonstrated fair or poor intubation condition.
Conclusion:
A combination of propofol-fentanyl can be used as an alternative to propofol-suxamethonium to ease intubation in paediatric patients.
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