Tracheal intubation in children using sevoflurane without muscle relaxant. A novel approach using apnea as clinical indicator

Introduction Many clinical indicators for tracheal intubation in children using sevoflurane without muscle relaxant have been used. None of the study showed 100% excellent intubating conditions. A single large study showing 80% excellent intubating conditions, noticed that persistence of spontaneous ventilation before intubation had very poor intubating conditions. So, our study aimed to achieve apnea based on induction time using sevoflurane before intubation and observe the intubating conditions and hemodynamic variations in one hundred and fifty ASA I and II patients aged between one year to six years posted for ophthalmic procedures under general anaesthesia. Methods Based on the results of pilot study, all patients were induced with sevoflurane in 100% oxygen with 7 L/min flow via facemask. Glycopyrrolate 0.06 mg/kg, fentanyl 1 mcg/kg was given intravenously. Induction was done in slow incremental manner upto 8 vol% for 4.5 min (0 vol% to 8 vol% over 2.5 to 3 minutes). Propofol 1 mg/ kg was given intravenously at 4.5 min. Ventilation was controlled after achieving apnea on their own based on capnography and respiratory pattern by positive pressure mask ventilation. Laryngoscopy and tracheal intubation was performed at 5.5 minutes. Intubating conditions were assessed using Steyn's modification of HelboHansen scoring system and hemodynamic parameters were measured at 0, 3, 4.5, 5.5 and 6.5 minutes after induction. Results 96 out of 150 patients achieved apnea at 4.5 min and all 150 patients achieved apnea after giving propofol 1 mg/kg. Intubating conditions were excellent in all the cases without any complications. There was decrease in HR at 5.5 min compared to 3 min. There was decrease in Systolic and Diastolic blood pressure at 3, 4.5 and 5.5 minute intervals when compared to baseline value at 0 min (at 5.5 minutes was 15.58% and 12.75% compared Pediatric Anesthesia and Critical Care Journal 2015; 3(1):53-60 doi:10.14587/paccj.2015.10 Kumar. Tracheal intubation in children 54 to baseline respectively. Conclusions Apnea was achieved and excellent intubating conditions were observed in all the patients without any complications during induction with sevoflurane of 8 vol% by 5.5 minutes beforelaryngoscopy and tracheal intubation.