Intubating conditions and adverse events during sevoflurane induction in infants

Abstract

Background: The aim of this study was to compare intubating conditions and adverse events after sevoflurane induction in infants, with or without the use of rocuronium or alfentanil.MethodsSeventy-five infants, aged 124 months, undergoing elective surgery under general anaesthesia were randomly assigned to receive 8 sevoflurane with either placebo (i.v. saline 0.5 ml kg-1), rocuronium (0.3 mg kg-1), or alfentanil (20 g kg-1). The primary outcome measure was intubating conditions evaluated 90 s after test drug injection by an anaesthetist unaware of the patients group. The secondary outcome criteria were respiratory (, laryngospasm, closed vocal cords preventing intubation, bronchospasm) and haemodynamic adverse events (heart rate and mean arterial pressure variations <30 control value).ResultsIntubating conditions were significantly better in the rocuronium group, with clinically acceptable intubating conditions in 92, vs 70 in the alfentanil group and 63 in the placebo group (P0.044). Adverse respiratory events were significantly less frequent in the rocuronium group: 0 vs 33 in the placebo group and 30 in the alfentanil group (P0.006). Haemodynamic adverse events were more frequent in the alfentanil group: 48 vs 7 in the placebo group and 16 in the rocuronium group (P0.0019).ConclusionsIn 1- to 24-month-old infants, the addition of 0.3 mg kg-1 rocuronium to 8 sevoflurane improved intubating conditions and decreased the frequency of respiratory adverse events. Alfentanil provided no additional benefit in this study. © The Author [2010]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.