The effect of different doses of propofol on tracheal intubating conditions without muscle relaxant in children.

BACKGROUND AND OBJECTIVE: Situations may occur in anaesthetic practice where the use of neuromuscular blocking drugs is unsuitable or contraindicated. We investigated the use of propofol given 5 min after fentanyl to permit endotracheal intubation in children.

METHODS: We studied the intubating conditions and cardiovascular parameters in 60 ASA I and II children. Intravenous midazolam (0.1 mg kg(-1)) was given as premedication 5 min before the induction of anaesthesia. The children received different doses of propofol (group I, 2.5 mg kg(-1); group II, 3.0 mg kg(-1); group III, 3.5 mg kg-1) preceded by fentanyl (3.0 microg kg(-1)) given 5 min earlier. No neuromuscular blocking agents were administered. The intubating conditions were assessed using a four-point scoring system based on the degree of difficulty of laryngoscopy, the position of vocal cords and the intensity of coughing.

RESULTS: Tracheal intubating conditions were adequate in 20% of the patients in group I, in 75% of the patients in group II and in 80% of the patients in group III (P < 0.05 for group I vs. groups II and III). Haemodynamic changes were not significantly different between the groups.

CONCLUSIONS: Propofol (3.0 mg kg(-1)) preceded by fentanyl (3.0 microg kg(-1)) was adequate for the induction of anaesthesia in children and provided adequate tracheal intubating conditions without significant haemodynamic changes. This method represents a useful alternative technique for tracheal intubation when neuromuscular blocking drugs are contraindicated or should be avoided.