title: The effect of adjuvant drugs on the quality of tracheal intubation without muscle relaxants in children: a systematic review of randomized trials.
abstract: Intubation without prior administration of muscle relaxants is a common practice in children. However, succinylcholine may be considered as the golden standard for optimizing intubating conditions. We conducted a systematic review of the literature to identify drug combinations that included induction of anesthesia with sevoflurane or propofol. Our aim was to select drug combinations that yield excellent intubating conditions ≥80%; we identified six combinations in children aged 1-9 years. Sevoflurane with remifentanil (1 or 2 μg·kg(-1) ), lidocaine (2 mg·kg(-1) ), or propofol (2 mg·kg(-1) ) as the adjuvant shared the following characteristics: premedication with midazolam and/or ketamine, long sevoflurane exposure time, high inspired and endtidal sevoflurane concentration, and assisted ventilation. One combination using sevoflurane with propofol (3 mg·kg(-1) ) without premedication, with shorter sevoflurane exposure time, and spontaneous breathing indicated that propofol may be the adjuvant of choice for a rapid sevoflurane induction. The only adjuvant identified in propofol induction was remifentanil (4 μg·kg(-1) ). No serious adverse events were reported with these combinations.
authors.affiliation: Department of Anesthesiology, American University of Beirut-Medical Center, Beirut, Lebanon.  
authors.forename: Marie T
authors.initials: MT
authors.lastname: Aouad
authors.forename: Vanda G
authors.initials: VG
authors.lastname: Yazbeck-Karam
authors.forename: Claude E
authors.initials: CE
authors.lastname: Mallat
authors.forename: Jean J
authors.initials: JJ
authors.lastname: Esso
authors.forename: Sahar M
authors.initials: SM
authors.lastname: Siddik-Sayyid
authors.forename: Roland N
authors.initials: RN
authors.lastname: Kaddoum
mesh_terms: D000759:Adjuvants, Anesthesia / Q000009:adverse effects; D000293:Adolescent; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000379:methods*; D008012:Lidocaine; D008297:Male; D008738:Methyl Ethers; D009125:Muscle Relaxants, Central; D009467:Neuromuscular Depolarizing Agents; D009609:Nitrous Oxide; D010880:Piperidines; D011229:Preanesthetic Medication; D015742:Propofol; D016032:Randomized Controlled Trials as Topic; D000077208:Remifentanil; D000077149:Sevoflurane; D013390:Succinylcholine
chemical_list: D000759:Adjuvants, Anesthesia; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D008738:Methyl Ethers; D009125:Muscle Relaxants, Central; D009467:Neuromuscular Depolarizing Agents; D010880:Piperidines; D000077149:Sevoflurane; D008012:Lidocaine; D013390:Succinylcholine; D009609:Nitrous Oxide; D000077208:Remifentanil; D015742:Propofol