Details
Category: Volume 07 Issue 03 March 2019
Hits: 1042

Title: Evaluation of Intubating Condition using Propofol and Propofol Plus Sevoflurane: A Randomized Controlled Trial

Author: Pradipta Kumar Patel, Sumati Kandi, Ratikanta Nayak, Saransh Mishra

 DOI: https://dx.doi.org/10.18535/jmscr/v7i3.238

Abstract

Background and Aims: The purpose of the present study was

  • To study and compare the ease of intubation with combination of Sevoflurane4% and Propofol 1.5mg/kg with IV Propofol 3mg/ kg alone.
  • To study the quality of intubation at first attempt.
  • To study the hemodynamic response during induction and intubation

Materials and Methods: The study was conducted in 80pts of ASA I & II, non obese, adult patients aged between 20-40yrs coming for elective surgical procedures under General Anaesthesia. Anaesthesia was induced in Group A patients by 67% N2O in O2 and IV propofo 3 mg/kg injected over 30s. Group B patients were induced by mask with sevoflurane starting at 0.5% and incrementally increased to 4% inhaled concentration with 67% nitrous oxide in oxygen at a total gas flow of 8 liters/min and IV propofol 1.5mg/kg injected over 15s and tracheal intubation was attempted at 240s after the start of induction in both groups. The heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure before and after induction and post-intubation at 1, 3 and 5 minutes were recorded. Intubating conditions were assessed by anaesthesiologist who performed intubation using Copenhagen Consensus Conference (CCC)18 intubation score.

Results: Overall acceptable intubating conditions were significantly associated with Group B when compared with Group A. Number of attempts were significantly less in Group B when compared to Group A.

Conclusion: We concluded that combination of inhalational 4% sevoflurane with IV propofol 1.5mg/kg is superior to IV propofol 3mg/kg with respect to quality of intubation and less significance with respect to hemodynamic response during induction and intubation in adult patients undergoing various elective surgical procedures without muscle relaxants and also this combination is cost effective.

Keywords: Propofol, Sevoflurane, Copenhagen  Consensus Conference intubation  (CCC)Score.

References

  1. Woods AW, Allam S. Tracheal intubation without the use of neuromuscular blocking agents. Br J Anaesth 2005; 94: 150-158.
  2. Srivastava U, Kumar A, Gandhi NK, Saxena S, Agarwal S. Comparison of propofol and fentanyl with thiopentone and suxamethonium for tracheal intubation in children. Ind J Anaesth 2001; 45: 263-266.
  3. Steyn MP, Quinn AM, Gillespie JA, Miller DC, Best CJ, Morton NS. Tracheal intubation without neuromuscular block in children. Br J Anaesth 1994; 72: 403-406.
  4. Akhilesh Gupta, Ranvinder Kaur, Rohit Malhotra, Suniti Kale. Comparative evaluation of different doses of propofol preceded by fentanyl on intubating conditions and pressor response during tracheal intubation without muscle relaxants. Paediatric Anaesthe 2006; 16: 399-405.
  5. Robinson AL, Jerwood DC, Stokes MA. Routine suxamethonium in children. Anesthesia 1996 51 (9): 874 -78
  6. Scheller MS, Zornow MH, Saidman LJ. Tracheal intubation without the use of musclerelaxants: a technique by using propofol and varying doses of alfentanyl.Anesth. Analg 1992 ; 75(5) 788 -93
  7. Francois D. Tracheal intubation: unconsciousness, analgesia and muscle relaxation. Can J Anesth 2003; 50: 99-103.
  8. Hannallah RS, Britton JT, Schafer PG, Patel RI, Norden JM. Propofol anaesthesia in paediatric ambulatory patients: A comparison with thiopentone and halothane. Can J Anaesth 1994; 41: 12-18.
  9. Abdel-Halim JMK, Azer MS, El-Awady GA. Comparison of induction and recovery characteristics of sevoflurane, halothane and propofol in pediatric outpatients. Journal of the Egyptian Nat. Cancer Inst 2002; 14: 319-323.
  10. Politis GD, Tobin JR,Morell RC, James RL, Cantwell MF.Tracheal intubation of healthy pediatric patients without muscle relaxants : a survey of technique utilization and perceptions of safety.Anesth.Analg 1999;88(4): 733 -4.
  11. Politis GD, Frankland MJ,James RL,Reville JF ,Ricker MP,Petree BC.Factors associated with successful tracheal intubation of children with sevoflurane and no muscle relaxants.Anesth. Analg 2002;95(3): 615 – 20
  12. Simon L, Boucebci KJ, Orliaquet G, Aubineau JV,Devys JM, Dubousset AM.A survey of practice of tracheal intubation without muscle relaxant in pediatric patients. Pediatric Anesthesia 2002;12(1):36 - 42
  13. Muzi M,Robinson BJ,Ebert TJ,O’Brien TJ.Induction of anesthesia and t ra ch ea l in tu ba t io n  wi th  s ev of l ur an e  in a du lt s .A ne st he si ol og y 1996;85(3):536 – 43
  14. Hansen D, Schaffartzik W, Dopjans D, Heitz E, Striebel HW. Halothane- propofol anaesthesia for tracheal intubation in young children. Br J Anaesth1997; 78: 366-369.
  15. Jellish WS, Lien CA, Fontenot HJ, Hall R. The comparative effects of sevoflurane versus propofol in the induction and maintenance of anesthesia in adult patients. Anesth Analg 1996; 82: 479-485.
  16. Thwaites AJ, Edmends S, Tomlinson AA, Kendall JB, Smith I. Double-blind comparison of sevoflurane vs propofol and succinylcholine for tracheal intubation in children. Br J Anaesth 1999; 83: 410-414.
  17. Sayyid SMS, Aouad MT, Taha SK, Daaboul DG, Deeb PG, Massouh FM, Muallem MRA, Baraka AS. A comparison of sevoflurane-propofol versus sevoflurane or propofol for laryngeal mask airway insertion in adults. Anesth Analg 2005; 100: 1204-1209.
  18. Coates D, Prys-Roberts C, Spelina K: Propofol (Diprivan) by intravenous infusion with nitrous oxide: Dose requirements and hemodynamic effects. Postgrad Med J 1985; 61:76.
  19. Pramod Kumar Bithal, Atlaf Soudagar, Mallika Paul, Ayham Bali. Comparison of halothane with sevoflurane inhalation in children for tracheal intubation. Ind J Anaesth 2000; 44: 47-54.
  20. Swadia VN, Mamta GP. Comparison of induction and of sevoflurane and halothane in paediatric patients. Ind J Anaesth 2001; 45(4): 294-297.

Corresponding Author

Ratikanta Nayak

Junior Resident, Department of Anaesthesiology, VIMSAR, Burla