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KMID : 1155520100050010082
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Anesthesia and Pain Medicine
2010 Volume.5 No. 1 p.82 ~ p.86
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The optimal clinical dose of alfentanil for tracheal intubation during inhalation induction with sevoflurane after sedation with ketamine in children
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Kim Joon-Sik
Lee Dong-Chul
Kim Ji-Young
Kwak Hyun-Jeong
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Abstract
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Background: The purpose of this study was to determine the clinical effective dose of alfentanil required for successful tracheal intubation during inhalation induction using 5% sevoflurane without neuromuscular blockade in children sedated with ketamine.
Methods: Twenty-one children, aged 3?10 years, undergoing surgeries under general anesthesia were enrolled into the study. All patients were premedicated with 0.004 mg/kg glycopyrrolate intramuscularly 30 min before anesthesia.To facilitate separation of the child from the parents, intravenous 1 mg/kg ketamine was given prior to transfer into the operating room.After inhalation induction with 5% sevoflurane and 100% oxygen, pre-determined dose of alfentanil was injected over 20 sec. The dose of alfentanil was determined by modified Dixon’s up-and-down method (2?g/kg as a step size starting from 12?g/kg).The study ended when six independent pairs of patients, who manifested cross over from ’failure’ to ’success’ for tracheal intubation, were recruited.
Results: In 50% of children, the effective bolus dose (ED50) (95% confidence intervals) of alfentanil for successful tracheal intubation was 7.2?g/kg (6.3?8.1?g/kg) during sevoflurane inhalation induction.From isotonic regression, 95% effective dose (ED95) (95% confidence intervals) of alfentanil was 9.9?g/kg (2.2?16.0 ?g/kg).
Conclusions: During inhalation induction using 5% sevoflurane without neuromuscular blockade after ketamine sedation, the ED50 and ED95 of alfentanil for successful tracheal intubation were 7.2 ?g/kg and 9.9?g/kg in children, respectively.
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KEYWORD
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Alfentanil, Child, Inhalation induction, Ketamine, Sevoflurane
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