Assessment of Intubating Conditions with Different Doses of Propofol without Muscle Relaxant in Children

Background: The aim of our study was to assess of tracheal intubation by different doses of propofol preceded by fentanyl for successful tracheal intubation and to see its effectiveness in blunting pressors response in children aged 2-10 years. Methods: This prospective, blind, randomized study was conducted on 120 ASA grade I and II children, between 2 and 10 years undergoing elective surgery who were divided into three groups. The children received different doses of propofol (group I, 2.5 mg/kg; group II, 3.0 mg/kg; and group III, 3.5 mg/kg) preceded by a fixed dose of fentanyl (2 μg/kg) 5 min earlier. The tracheal intubating conditions were graded based on scoring system devised by Helbo-Hensen et al. with Steyn modification which includes five criteria; ease of laryngoscopy, degree of coughing, position of vocal cords, jaw relaxation, and limb movement and graded on a 4-point scale. Heart rate (HR) and mean arterial pressure (MAP) changes were also noted. Results: Tracheal intubating conditions were acceptable in 65% of the patients in group I, while significantly higher (P<0.001) in group II (97.5%) and in group III (100%). The pressor response was not effectively blunted in group I (17% increases in HR), while effectively blunted in groups II and III. A fall in hemodynamic was seen in group III indicated by a decrease in MAP (16%) and HR (11%). No airway complications were noted. Conclusions: Propofol 3.5 mg/kg (group III) preceded by fentanyl 2 μg/kg is the excellent dose combination in our study. It provides acceptable intubating conditions in 100% patients, blunts pressor response to intubation without significant cardiovascular depression.