A survey of practice of tracheal intubation without muscle relaxant in paediatric patients.
BACKGROUND
Because of the renewed interest in intubation in children without relaxants, over a period of 1 month, the anaesthesiologists of five paediatric universitary teaching hospitals were asked to complete a questionnaire each time they performed a tracheal intubation without muscle relaxant.


METHODS
Intubating conditions were assessed with five items. Each item was graded on a four-point scale. Intubating conditions were judged acceptable when all items scored 2 or less. Episodes of oxygen desaturation and failed intubations were noted. Data are expressed as mean +/- SD (extremes).


RESULTS
Five hundred and two questionnaires were completed during the study period. Children were aged 61 +/- 50 (1-180) months old. Induction of anaesthesia was performed with sevoflurane for 62.6% of the children (endtidal concentration 5.9 +/- 1.5%) and propofol for 28.9% (dose 5.8 +/- 4.2 mg x kg(-1). Opioids were associated with these hypnotics in 53.2% of the children. Tracheal intubation was successful in 87.1% of the children. Sevoflurane produced better intubating conditions than propofol. Sevoflurane requirements for tracheal intubation may be higher in infants aged less than 6 months old than in older children. A severe decrease in SpO2 (< or = 90%) was observed in 15.9% of the infants aged less than 1 year old and in 1.7% of the children, respectively (P < 0.0001).


CONCLUSIONS
Sevoflurane is the most commonly used agent for tracheal intubation without relaxants with higher doses being required in infants aged less than 6 months. Propofol, even with opioids, was not so successful.
Simon
Lionel
L
Hôpital Saint Vincent de Paul, Assistance Publique-Hôpitaux de Paris, Paris, France.
Boucebci
Karim J
KJ
Orliaguet
Gilles
G
Aubineau
Jean-Vincent
JV
Devys
Jean-Michel
JM
Dubousset
Anne-Marie
AM
D000293:Adolescent; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D008738:Methyl Ethers; D009125:Muscle Relaxants, Central; D015742:Propofol; D000077149:Sevoflurane; D011795:Surveys and Questionnaires
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D009125:Muscle Relaxants, Central; D000077149:Sevoflurane; D015742:Propofol