Orotracheal intubation conditions without neuromuscular relaxants in pediatric patients

Abstract

The use of muscle relaxants has become a fundamental part of the orotracheal intubation (OTI) technique due to the safety they provide when carrying it out. However, there are circumstances in which its use may be undesired or contraindicated. To deal with these situations, numerous techniques have been developed that involve the combination of intravenous agents, inhaled agents, and opioids applied in different ways to achieve muscle relaxation. Due to their characteristics, Propofol and Remifentanil would be the most suitable for this purpose, so they will be used under the same induction technique, with and without muscle relaxant. Aim: To compare intubation conditions and hemodynamic parameters after IOT in children with and without neuromuscular relaxants.

Retrospective, comparative and observational design study, approved by the institutional ethics committee, comprising 40 children of both sexes between the ages of 3 and 10 years who had been administered general anesthesia and were divided into two groups of twenty cases A and B. Both groups received an induction of remifentanil 3 µg/kg - propofol 3.5 mg/kg-lidocaine 1mg/kg, group B also receiving rocuronium 0.6 mg/kg. Next, intubation conditions and hemodynamic parameters were compared.

The analysis of the hemodynamic patterns in the studied sample showed statistically significant differences for the diastolic and mean blood pressure values in relation to the induction before and after orotracheal intubation, but not for said values after 5 minutes. Therefore, it can be inferred that the clinical values in relation to the hemodynamic effects before and after orotracheal intubation were similar for both techniques. No significant differences were found when comparing the orotracheal intubation conditions, which were therefore clinically acceptable in 100% of the patients.

Orotracheal intubation in pediatric patients using a combination of Remifentanil 3 µg/kg -propofol 3.5 mg/kg-lidocaine 1mg/kg provides similar intubation conditions as the same associated with muscle relaxants.