Section Editor: Jerrold Lerman
The effect of adjuvant drugs on the quality of tracheal intubation without muscle relaxants in children: a systematic review of randomized trials
Article first published online: 11 APR 2012
© 2012 Blackwell Publishing Ltd
Volume 22, Issue 7, pages 616–626, July 2012
How to Cite
Aouad, M. T., Yazbeck-Karam, V. G., Mallat, C. E., Esso, J. J., Siddik-Sayyid, S. M. and Kaddoum, R. N. (2012), The effect of adjuvant drugs on the quality of tracheal intubation without muscle relaxants in children: a systematic review of randomized trials. Pediatric Anesthesia, 22: 616–626. doi: 10.1111/j.1460-9592.2012.03845.x
Work attributed to Department of Anesthesiology, American University of Beirut-Medical Center.
- Issue published online: 1 JUN 2012
- Article first published online: 11 APR 2012
- Accepted 6 March 2012
- child airway;
- intravenous agents
Intubation without prior administration of muscle relaxants is a common practice in children. However, succinylcholine may be considered as the golden standard for optimizing intubating conditions. We conducted a systematic review of the literature to identify drug combinations that included induction of anesthesia with sevoflurane or propofol. Our aim was to select drug combinations that yield excellent intubating conditions ≥80%; we identified six combinations in children aged 1–9 years. Sevoflurane with remifentanil (1 or 2 μg·kg−1), lidocaine (2 mg·kg−1), or propofol (2 mg·kg−1) as the adjuvant shared the following characteristics: premedication with midazolam and/or ketamine, long sevoflurane exposure time, high inspired and endtidal sevoflurane concentration, and assisted ventilation. One combination using sevoflurane with propofol (3 mg·kg−1) without premedication, with shorter sevoflurane exposure time, and spontaneous breathing indicated that propofol may be the adjuvant of choice for a rapid sevoflurane induction. The only adjuvant identified in propofol induction was remifentanil (4 μg·kg−1). No serious adverse events were reported with these combinations.