title: Evaluation of endotracheal intubating conditions without the use of muscle relaxants following induction with propofol and sevoflurane in pediatric cleft lip and palate surgeries.
abstract: OBJECTIVE
  Children with facial clefts are usually difficult to intubate and it is considered safer to keep them spontaneously breathing while securing the airway. This prospective comparative study was conducted to evaluate endotracheal intubating conditions in pediatric patients undergoing cleft surgeries, without the use of muscle relaxants following induction with propofol and sevoflurane.
  
  
  METHODS
  Sixty patients aged 1month to 3 years, were randomly allocated into two equal groups. Anesthesia was induced with sevoflurane 8% in oxygen in group 1 and with propofol 3 mg/kg in group 2. Laryngoscopy and intubation were attempted 150 s after induction in both groups and ease of laryngoscopy, position of vocal cords, degree of coughing, jaw relaxation, and limb movements were assessed and scored. Total score of 5 was considered excellent, 6-10 good, 11-15 poor, and 16-20 bad. Total score ≤ 10 was considered clinically acceptable, and >10 as clinically unacceptable. Chi-square and Wilcoxon Mann-Whitney tests were used to analyze data.
  
  
  RESULTS
  There was no significant difference between groups when ease of laryngoscopy was compared. Sevoflurane induced patients had significantly better position of vocal cords at intubation and the propofol group had significantly more episodes of coughing. Significantly less number of patients had limb movements in sevoflurane group. There was no significant difference in degree of jaw relaxation between groups. The sevoflurane group had significantly better total scores and clinically acceptable intubating conditions.
  
  
  CONCLUSIONS
  Sevoflurane 8% in oxygen provides clinically acceptable intubating conditions without use of muscle relaxants in pediatric cleft patients.
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Rajan
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Gotluru
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Susamma
authors.initials: S
authors.lastname: Andews
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Jerry
authors.initials: J
authors.lastname: Paul
keywords: Intubation without muscle relaxants; pediatric cleft surgeries; sevoflurane induction