title: Intubating conditions and adverse events during sevoflurane induction in infants.
abstract: BACKGROUND
  The aim of this study was to compare intubating conditions and adverse events after sevoflurane induction in infants, with or without the use of rocuronium or alfentanil.
  
  
  METHODS
  Seventy-five infants, aged 1-24 months, undergoing elective surgery under general anaesthesia were randomly assigned to receive 8% sevoflurane with either placebo (i.v. saline 0.5 ml kg⁻¹), rocuronium (0.3 mg kg⁻¹), or alfentanil (20 µg kg⁻¹). The primary outcome measure was intubating conditions evaluated 90 s after test drug injection by an anaesthetist unaware of the patient's group. The secondary outcome criteria were respiratory (Sp(O₂) <90%, laryngospasm, closed vocal cords preventing intubation, bronchospasm) and haemodynamic adverse events (heart rate and mean arterial pressure variations ≥30% control value).
  
  
  RESULTS
  Intubating conditions were significantly better in the rocuronium group, with clinically acceptable intubating conditions in 92%, vs 70% in the alfentanil group and 63% in the placebo group (P=0.044). Adverse respiratory events were significantly less frequent in the rocuronium group: 0% vs 33% in the placebo group and 30% in the alfentanil group (P=0.006). Haemodynamic adverse events were more frequent in the alfentanil group: 48% vs 7% in the placebo group and 16% in the rocuronium group (P=0.0019).
  
  
  CONCLUSIONS
  In 1- to 24-month-old infants, the addition of 0.3 mg kg⁻¹ rocuronium to 8% sevoflurane improved intubating conditions and decreased the frequency of respiratory adverse events. Alfentanil provided no additional benefit in this study.
authors.affiliation: Department of Anaesthesia and Critical Care, Fondation Ophtalmologique Adolphe de Rothschild, 25–29 rue Manin, 75019 Paris, France. jmdevys@fo-rothschild.fr
authors.forename: J M
authors.initials: JM
authors.lastname: Devys
authors.forename: G
authors.initials: G
authors.lastname: Mourissoux
authors.forename: F X
authors.initials: FX
authors.lastname: Donnette
authors.forename: R
authors.initials: R
authors.lastname: Plat
authors.forename: F
authors.initials: F
authors.lastname: Schauvliège
authors.forename: P
authors.initials: P
authors.lastname: Le Bigot
authors.forename: P
authors.initials: P
authors.lastname: Dureau
authors.forename: B
authors.initials: B
authors.lastname: Plaud
mesh_terms: D015760:Alfentanil; D000701:Analgesics, Opioid; D000732:Androstanols; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D002675:Child, Preschool; D004311:Double-Blind Method; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods; D008738:Methyl Ethers / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents; D011446:Prospective Studies; D012120:Respiration Disorders / Q000209:etiology / Q000517:prevention & control; D000077123:Rocuronium; D000077149:Sevoflurane
chemical_list: D000701:Analgesics, Opioid; D000732:Androstanols; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D015760:Alfentanil; D000077149:Sevoflurane; D000077123:Rocuronium