Endotracheal Intubation With Sevoflurane in Surgical Pediatric Patients
Condition: Anesthesia; Reaction
Study type: Interventional

Summary: 
      Aim of the study is to compare the optimal time needed for successful tracheal intubation
      with immediate 8% sevoflurane and incremental sevoflurane induction in surgical pediatric
      patients undergoing adenotonsillectomy without using muscle relaxants or opioids
    

Detailed description: 
      Investigators studied 100 pediatric surgical patients admitted to Sulaimani Teaching Hospital
      in the Otorhinolaryngology, Head and Neck Surgical Department, from the first of June 2011 to
      the first of September 2011, Children aged 2-7 years,both genders, ASA physical statuses І
      and II (ASA I: a healthy normal patient, while ASA II: a patient with mild systemic disease
      with no functional limitations) were scheduled for elective adenotonsillectomy operations.
      They were randomly divided into two equal groups according to the induction method.

      Group 1 (G1) using incremental induction with sevoflurane (1-8 %) in 100% O2, the vapor
      concentration is increased by 1% every few breaths.

      Group 2 (G2) high concentration of sevoflurane (8%) in 100% O2 from the beginning of
      induction.

      None of them is given premedication or any other adjunct drugs until successful intubation is
      done; ventilation was assisted and then controlled when possible. If upper airway obstruction
      occurred, an oropharyngeal airway was immediately inserted. Attempts were made to obtain
      venous access before laryngoscopy. All patients monitored with electrocardiography (ECG),
      noninvasive blood pressure monitoring (NIBP), pulse oximetry, and temperature measurements.

      Children with extreme weight, suspicion of difficult airway, moved during laryngoscopy, or
      more than one trial of laryngoscopy needed were excluded from this study.

      The endotracheal tube (ETT) size was selected by using the formula (age/4) + 4.5. Only a
      single laryngoscopy attempt was allowed. Small, brief movements of extremities occurring
      after (ETT) placement did not considered as exclusion criteria. Anesthesia was delivered by
      anesthetic machine (Datex Ohmeda), using an Ayer's T-piece with Jackson Ree's modification
      system, with a fresh gas flow of 6 L/min through a Sevoflurane vaporizer.

      Patients were observed until eyelash reflex disappears, pupils centered and constricted. Jaw
      relaxation and movements were monitored. Ventilation was controlled till the time of
      laryngoscopy; the vocal cords were completely visible, orotracheal intubation done with
      Macintosh laryngoscope blade size 2 by the same anesthetist for all the patients. The time
      from induction until successful tracheal intubation is recorded.
    

Intervention name(s): Sevoflurane
Intervention type(s): Drug
Intervention description(s): use of 8% sevoflurane in compared to incremental dose increased each few breaths from 1% to 8%
Other intervention name(s): sevorane abbott
Intervention MeSH terms: Sevoflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care
Keywords: induction; pediatrics; sevoflurane; intubation time