A comparative study between propofol-fentanyl versus propofol-suxamethonium for ease of endotracheal intubation in children

Background: Following propofol induction, suxamethonium tremendously improves intubating conditions in children and has been the gold standard agent for this purpose. However, suxamethonium could be absolutely contraindicated in some patients. Fentanyl, a short acting opioid, has been investigated as a suitable alternative with varying results. Aim and Objectives: This study compares the ease of tracheal intubation between propofol-suxamethonium (1.5 mg/kg) and propofol-fentanyl (3 mcg/kg) during general anaesthesia among children. Patients and Methods: In this double-blind randomised controlled study, 84 ASA I or II patients booked for elective surgery under general anaesthesia requiring tracheal intubation were randomised into two groups (F and S). Induction was with propofol 3 mg/kg over 30 s followed by either fentanyl 3 mcg/kg or suxamethonium 1.5 mg/kg. Two minutes later, there was an attempt at intubation and intubating conditions were assessed using Steyn's modification of Helbo-Hansen's score (ease of laryngoscopy, jaw relaxation, coughing, vocal cord position, and limb movement). Results: All patients in both groups had successful intubation at the first attempt. Patients in group S (suxamethonium) had significantly better overall intubating conditions compared to those in group F (fentanyl) (p=0.0001), 85.7% in group S compared to 21.4% in group F had excellent intubation condition. None of the patients in the two groups demonstrated fair or poor intubation condition. Conclusion: A combination of propofol-fentanyl can be used as an alternative to propofol-suxamethonium to ease intubation in paediatric patients.