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BJA Advance Access published online on March 31, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep044
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Optimal dose of sufentanil in children for intubation after sevoflurane induction without neuromuscular block

A. Soulard1,*, F. Babre1, M. Bordes1, Y. Meymat1, F. Sztark2 and A. M. Cros1

1 Département d’Anesthésie-Réanimation IV
2 Département d’Anesthésie-Réanimation I, Hôpital Pellegrin, 33076 Bordeaux cedex, France

* Corresponding author. E-mail: alexis.soulard{at}chu-bordeaux.fr

Background: We studied 63 ASA I children (age 2–8 yr) to determine the sufentanil dose needed to facilitate intubation under excellent conditions after inhalation induction with various end-tidal concentrations of sevoflurane without neuromuscular block.

Methods: Subjects were allocated randomly to receive sevoflurane end-tidal concentrations (E'sevo) of 2.5%, 3%, or 3.5%. Anaesthesia was induced with sevoflurane 6% without nitrous oxide for 2 min, and then inspired sevoflurane concentration was adjusted to keep E'sevo at 2.5%, 3%, or 3.5% according to the group. Subjects received i.v. sufentanil according to an ‘up and down’ design. Tracheal intubation by direct laryngoscopy was performed 6 min after sufentanil injection. Intubation was considered successful, if intubation conditions were excellent as determined by the laryngoscopist.

Results: The ED50 [effective dose for 50% of subjects; mean (SD)] of sufentanil required for excellent intubation conditions was 0.6 (0.12), 0.32 (0.10), or 0.11 (0.07) µg kg–1 for E'sevo of 2.5%, 3%, or 3.5%, respectively. Using logistic analysis, the 95% effective dose (ED95) of sufentanil was 1.02 [95% confidence intervals (CI) 0.31–1.74] µg kg–1, 0.58 (95% CI 0.17–0.99) µg kg–1, or 0.28 (95% CI 0.04–0.52) µg kg–1 for E'sevo of 2.5%, 3%, or 3.5%, respectively.

Conclusions: Excellent intubation conditions could be obtained in children after inhalation induction with low sevoflurane concentrations and adjuvant sufentanil.

Keywords: anaesthesia, paediatric; anaesthetics volatile, sevoflurane; analgesics opioid, sufentanil; equipment, tubes, tracheal


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Sufentanil for Intubation: Does this make it easier for the anesthesiologist?
R.Dean Nava, et al.
British Journal of Anaesthesia, 14 Apr 2009 [Full text]

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