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Clinical Research
Pediatric Anesthesia
Anesthesia and Pain Medicine 2010;5(1):82-86.
Published online January 30, 2010.
The optimal clinical dose of alfentanil for tracheal intubation during inhalation induction with sevoflurane after sedation with ketamine in children
Joon Sik Kim, Ji Young Kim, Dongchul Lee, Hyun Jeong Kwak
1Department of Anesthesiology, Yonsei University College of Medicine, Seoul, Korea.
2Department of Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
3Department of Anesthesiology, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea. hyun615@gilhospital.com
Abstract
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 (2microgramkg as a step size starting from 12microgramkg).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 7.2microgram/kg (6.3-8.1microgram/kg) during sevoflurane inhalation induction.From isotonic regression, 95% effective dose (ED95) (95% confidence intervals) of alfentanil was 9.9microgram/kg (2.2-16.0microgram/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 microgram/kg and 9.9microgram/kg in children, respectively.
Key Words: Alfentanil, Child, Inhalation induction, Ketamine, Sevoflurane
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