استفاده از پروپوفول ورمي فنتانيل بدون شل كننده عضلاني جهت لوله گذاري نازوتراكيال در كودكان

The Use of Propofol and Remifentanil without Muscle Relaxants for Nasotracheal Intubation in Children

Introduction & Objective: Common practice in induction of anesthesia for tracheal intubation is the administration of hypnotic drugs followed by a muscle relaxant. The use of muscle relaxants in short time operations is controversial due to their side effects and prolonged paralysis. Materials & Methods: We evaluated the nasotracheal intubating conditions in 76 healthy premedicated children after propofol 2.5 mg/kg combined with either a bolus of remifentanil 2p/kg (study group) or suxamethonium 1.5 mg/kg (control group).Nasotracheal intubations were done by a blinded anesthetist and intubating conditions were graded using a four point scoring system based on mask ventilation feasibility, jaw relaxation, position of vocal cords and degree of coughing and limb movement. Also homodynamic and respiratory parameters were monitored. Results: Intubating conditions were acceptable in 36/40 (90%) and 34/36 (94.4%) of remifentanil and suxamethonium group respectively. There were no significant differences in all scores between two groups except of coughing and limb movement that was lower in control compared to remifentanil group. Also subjects who received remifentanil have lower blood pressures and heart rates after tracheal intubation in compared to another group, but these hemodynamic changes were well tolerated by the patients. Only in two patients atropine was administered for treatment of bradycardia. Conclusion: Remifentanil 2p/kg following propofol 2.5 mg/kg provides acceptable nasotracheal intubating conditions in the most of the cases without muscle relaxants.