Propofol 2 mg/kg is superior to propofol 1 mg/kg for tracheal intubation in children during sevoflurane induction

Abstract

Propofol has been used to facilitate tracheal intubation within a short time of sevoflurane induction without a muscle relaxant in children. We compared as the primary outcome the incidence of excellent intubating conditions after 8% sevoflurane and propofol 1 or 2 mg/kg. One hundred and four patients (2-7 years) were randomly assigned to receive propofol 1 mg/kg in group SP1 (n=53) or propofol 2 mg/kg in group SP2 (n=51) after inhalation induction using sevoflurane 8% in oxygen. Forty-five seconds after propofol and controlled ventilation, intubating conditions were assessed using a four-point scoring system based on ease of laryngoscopy, vocal cords position, coughing, jaw relaxation and limb movement. Heart rate and systolic blood pressure were measured as baseline, after sevoflurane induction, propofol, intubation and at 2 and 5 min following intubation. Three patients in group SP1 were excluded from analysis. Time from sevoflurane induction to intubation (248.9±71.3 s in group SP1 vs. 230.9±61.3 s in group SP2) and endtidal sevoflurane before intubation (5.6±1.6% in group SP1 vs. 5.2±1.5% in group SP2) did not differ between the two groups. The incidence of excellent intubating conditions was significantly higher in group SP2 compared with group SP1 [47/51 (92%) vs. 28/50 (56%)]. The incidence of acceptable intubating conditions was significantly higher in group SP2 compared with group SP1 [48/51 (94%) vs. 35/50 (70%)]. No hemodynamic difference was noted at any time point between the two groups. Propofol 2 mg/kg during 8% sevoflurane induction resulted in a higher proportion of excellent intubating conditions compared with propofol 1 mg/kg.