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PEDIATRIC ANESTHESIA

Factors Associated with Successful Tracheal Intubation of Children with Sevoflurane and No Muscle Relaxant

George D. Politis, MD MPH^*, Michael J. Frankland, MD, Robert L. James, MS, Jacland F. ReVille, MD, Michael P. Rieker, CRNA, and Betty C. Petree, CRNA

*Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia; and Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina

Address correspondence and reprint requests to Dr. Politis, Department of Anesthesiology, University of Virginia Health System, PO Box 800710, Charlottesville, VA 22908. Address e-mail to gdp8a{at}virginia.edu

Better definition of end points required to achieve successful tracheal intubation after induction with sevoflurane could improve patient care. The authors therefore designed a study that could determine, with meaningful confidence intervals, the time required to successfully intubate 80% of children by using 8% inspired sevoflurane and no muscle relaxant. We hypothesized that the time required could vary by age or body mass index. One-hundred fifty-three ASA physical status I or II patients received induction with 8% sevoflurane in 60% nitrous oxide with discontinuation of nitrous oxide 1 min after the start of the induction. The time until laryngoscopy remained close to the time required to achieve 80% successful intubation by varying induction time according to the success rate in each group of five patients. A probit model of induction time and age found that both were predictive of successful intubation (P values of 0.006 and 0.02, respectively). The induction times needed to achieve 80% successful intubation were 137 s (95% confidence interval, 94.6–159 s) and 187 s (153–230 s) for ages 1–4 yr and 4–8 yr, respectively. The persistence of spontaneous ventilation at the time of laryngoscopy, despite attempts to control ventilation, was associated with poor intubation conditions (P < 0.001).

IMPLICATIONS: To successfully intubate 80% of children by using sevoflurane and no muscle relaxant, induction times of 137 and 187 s were needed in children of 1–4 yr and 4–8 yr, respectively.

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