A study comparing either using intravenous propofol or topical lidocaine over the larynx as adjuncts to inhalational induction of anesthesia for facilitating nasotracheal intubation for pediatric patients undergoing tonsillectomy surgery

Abstract

Background Nasotracheal intubation in tonsillectomy surgery is used to facilitate surgical exposure. Intubation without muscle relaxant is commonly practiced for pediatric patients in ambulatory surgeries. Using adjuncts to inhalational induction makes more suitable conditions for intubation with hemodynamic stability and less laryngeal morbidities. In this study, lidocaine, 1% was used topically on vocal cords to facilitate nasotracheal intubation in comparison with intravenous propofol after inhalational induction using muscle relaxant only as a rescue medication in case of failure.Patients and methods A randomized controlled study was conducted on 96 patients aged 3–7 years and with American Society of Anesthesiologists physical status I and II scheduled for elective tonsillectomy. Patients were divided randomly into two equal groups, each consisting of 48 patients. Group P patients received inhalational induction using sevoflurane followed by propofol 2 mg/kg. Group L received inhalational induction by sevoflurane followed by topical lidocaine 1% on glottic and supraglottic areas. The intubation conditions, hemodynamic parameters (heart rate, mean blood pressure, and oxygen saturation), respiratory depression, sedation score, and incidence of laryngospasm after recovery were recorded and statistically analyzed.Results The intubation score was statistically significant with a high difference between the two groups. The score mean values were less than 10 with more success of the intubation in the lidocaine group. The success rate of intubation without the use of short-time-acting muscle relaxant was higher in the lidocaine group (88.89%) as compared with the propofol group (79.2%). Hemodynamic stability after intubation in the lidocaine group, was statistically significant. The incidence of postoperative laryngospasm was statistically nonsignificant, but the incidence rate was higher in the propofol group.Conclusion Using lidocaine 1% topically on the larynx can achieve an acceptable condition of the intubation without muscle relaxant in most of the cases, with hemodynamic stability and decreasing incidence of postoperative laryngospasm.