engleski

The induction dose-effect of propofol in addition to low-dose rocuronium on tracheal intubation conditions for day-case tonsillectomy in children

Tonsillectomy in children are a short surgical procedure performed in general anaesthesia on a day-case basis. Short-acting or low-dose intermediate-acting muscle relaxants are recommended (1). We supposed that induc-tion dose of propofol preceded by alfentanyl in addition to low-dose rocuronium might improve adequate intubation conditions (AIC). Ninety children (aged 5-11 yrs ; ASA I or II) were included in a prospective, randomized, double-blind-ed clinical study. All children were premedicated with midazo-lam 0.5 mg/kg. In thirty children anesthesia was induced with propofol in a dose of 2.0 (Group A), 2.5 (Group B) or 3.0 mg kg-1 (Group C) proceeded by alfentanyl (0.02 mg kg-1). In all groups, low-dose rocuronium (1.5 x ED50 ; 0.45 mg kg-1) was used. Maintenance was with propofol (0.1 mg kg-1 min-1) and alfentanyl (0.0015 mg kg-1 min-1). The intubation conditions were estimated (2). The AIC (excellent=E, good=G) were accep-ted if score in three variables (easy of laryngoscopy, movement of vocal cords and coughing) was equal or less than 2, and inade-quate (poor) if it was greater than 2. Data were analyzed with Fisher's exact and Mann-Whitney test. P<0.05 was regarded significant. Groups were comparable in demo-graphic data. Onset time of neuromuscular block did not differ between groups (A=3.2+/-0.4, B=3.1+/-0.4, C=3.1 +/- 0.4 min). Significant lower mean arterial pressure (MAP) was recorded immediately after bolus dose of 3.0 mg kg-1 of propofol (80+/-7, A=92+/-6 and B=90+/-9 mmHg)(p<0.05). AIC were achieved significantly higher after 3.0 (100%) [E=29(96.7%) G=1(3.3%)] and 2.5 mg kg-1of induction dose of propofol (97%)[E=25 (83.3%) compare with 2.0 mg kg-1(73%)[E=9(30%) G=21(70%)] (p<0.05). Induction dose of 2.5 mg kg-1 of propofol prece-ded by alfentanyl in addition to low-dose rocuronium improved the AIC without significant changes in MAP. This method repre-sents a recommended technique for elective day-case tonsillec-tomy in children where short duration of neuromuscular block is required. References 1 Moore EW, Pollard BJ, Elliott RE. European J Anaesth 2002 ; 19:9-17. 2 Viby-Mogensen J, Engbaek J, Eriksson LI et al. Acta Anaesthesiol Scand 1996 ; 40:59-71.

propofol; low-dose rocuronium; tonsillectomy; paediatric anaesthesia

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