Intubation Time Required for Tracheal Intubation with Low Dose Rocuronium in Children with and without Atropine

Abstract

PURPOSE: The purpose of this study was to determine the intubation time needed to facilitate tracheal intubation (TimeEI) with a low dose of rocuronium (0.3 mg/kg) during propofol induction and to determine whether this time was reduced by administration of atropine. METHODS: Forty-six children, aged 3-10 years, were randomly assigned to receive either saline (control group) or atropine 10 μg/kg (atropine group). Anesthesia was induced with alfentanil 10 μg/kg, propofol 2.5 mg/kg, and rocuronium 0.3 mg/kg. Each TimeEI at which tracheal intubation was attempted was predetermined according to the up-and-down method. TimeEI that provided excellent intubation conditions in 50% and 95% of patients was defined as TimeEI50 and TimeEI95, respectively. RESULTS: TimeEI50 ± SD was 160 ± 26.2 s and 150 ± 13.7 s in the control and atropine groups, respectively. Using isotonic regression, TimeEI95 in the control and atropine groups was 199 s (95% CI: 198.8-200.7 s) and 171 s (95% CI: 171.3-172.1 s), respectively. TimeEI95 was significantly higher in the control group than in the atropine group (P < 0.001). HR was significantly higher in the atropine group than in the control group during the study period. CONCLUSIONS: This study demonstrated that the TimeEI95 of a low dose of rocuronium (0.3 mg/kg) required for excellent tracheal intubation was 199 s during i.v. anesthesia induction using propofol and alfentanil in children. And, i.v. atropine (10 μg/kg) before anesthesia induction was able to reduce TimeEI95 by 28 s.

Purpose: 저자들은, 본 연구에서 propofol과 alfentanil을 이용한 소아환자의 마취유도 시 저용량의 rocuronium을 투여하였을 때의 성공적인 기관내삽관에 필요한 삽관시간(TimeEI)를 결정하고, atropine의 투여가 이(TimeEI)를 단축시킬 수 있는지 알아보고자 하였다. Methods: 3-10세의 소아환자 46명을 대상으로, 임의순서배정을 통해 생리식염수를 투여하는 대조군과 atropine(10 μg/kg)을 투여하는 아트로핀군으로 분류하였다. 모든 환자에게, alfentanil(10 μg/kg), propofol(2.5 mg/kg), rocuronium(0.3 mg/kg)으로 마취유도를 시행하였다. 각 환자에서의 TimeEI은 up-and-down 방법을 이용하여 결정하였다. 그리고 50%와 95%의 환자에서 성공적인 기관내삽관을 할 때 필요한 시간을 각각 TimeEI50과 TimeEI95로 정의하였다. Results: TimeEI50 ± SD는 대조군과 아트로핀군에서 각각 160 ± 26.2 초, 150 ± 13.7 초였다. 등위회귀(isotonic regression)를 이용한 TimeEI95는 대조군과 아트로핀군에서 199 초(95% CI: 198.8-200.7 초), 171 초(95% CI: 171.3-172.1 초)로, 대조군의 TimeEI95가 아트로핀군보다 높았다(P<0.001). 심박수는 아트로핀군에서 더욱 높았다(P<0.001). Conclusions: 본 연구에서 propofol과 alfentanil을 이용한 소아환자의 마취유도 시 저용량의 rocuronium(0.3 mg/kg)을 투여했을 때의 TimeEI95은 199 초였다. 그리고 마취유도 전 atropine(10 μg/kg) 투여를 통해 TimeEI95를 28 초 감소시킬 수 있었다.