Intubation without Muscle Relaxants: Sevoflurane Vs Halothane, A Comparison of Intubation Characteristics

Endotracheal intubation is one of the most important procedures undertaken during the induction of general anaesthesia for securing a patent airway. The administration of muscle relaxants has been associated with enormous side effects which include among others hyperkalaemia, raised intraocular and intracranial pressures, malignant hyperthermia, cardiac arrest and even death. Children are at an increased risk of desaturation, laryngospasm and airway obstruction during induction of anaesthesia. Induction in this group of patients is preferred with potent inhalational agents which can be used as an alternative to muscle relaxants to facilitate tracheal intubation and to further avoid the side effects mentioned. A randomized double blinded study conducted on 110 ASA I and II children aged less than five years who were scheduled for elective surgery under general anaesthesia were included and were randomly assigned into (2) groups namely groups S and H. Children in Group S were induced with sevoflurane to an end tidal concentration of 8% while those in group H were induced with halothane to an end tidal concentration of 2%. Laryngoscopy and tracheal intubation were attempted after the end-point was reached in both groups. The intubation conditions were assessed with the Steyn’s modification of Helbo-Hansen intubation condition score. A total score of ≤ 10 was considered clinically acceptable while a score ˃ 10 was considered clinically unacceptable. Statistical analysis was performed by using the unpaired t-test and the Chi-square test.  Significantly shorter time of induction was achieved in patients in group S compared to those in group H (p = 0.01). The overall intubation conditions were clinically acceptable in 98% and 92.7% in groups S and H respectively with no statistically significant difference, (p = 0.18). The commonest complications observed during this study were breath-holding (7.3%), laryngospasm (5.5%) and cough (3.6%) in group S while, in group H bradycardia (7.3%), breath-holding (5.5%) and hypotension (3.6%) were the commonest complications observed. The induction characteristics, haemodynamic variables and complications observed were comparable among the study groups, however, sevoflurane provided significantly shorter time of induction of anaesthesia compared to halothane.