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BJA: British Journal of Anaesthesia
Year: 2010  |  Volume: 104  |  Issue: 5  |  Page No.: 628 - 632

Optimal bolus dose of alfentanil for successful tracheal intubation during sevoflurane induction with and without nitrous oxide in children

H. J Kwak, J. Y Kim, S. K Min, J. S Kim and J. Y. Kim    

Abstract: Background

The goals of this study were to determine the effective bolus dose of alfentanil required for successful tracheal intubation during inhalation induction using sevoflurane 5% without neuromuscular block in children, and whether nitrous oxide reduces these doses.

Methods

Fifty paediatric patients, aged 3–10 yr, were randomly assigned to one of the two groups. Subjects received either sevoflurane 5% in oxygen 100% (O2 group, n=25) or sevoflurane 5% in oxygen 40% and nitrous oxide 60% (N2O group, n=25) through a face mask. One minute after inhalation induction, a predetermined dose of alfentanil was injected over 15 s. The alfentanil dose was determined using Dixon's up-and-down method, starting from alfentanil 14 µg kg–1. The trachea was intubated 3 min after inducing anaesthesia.

Results

The ED50 [95% confidence interval (CI)] of alfentanil for successful tracheal intubation was 11.5 (9.9–13.1) and 8.6 (7.4–9.8) µg kg–1 in the O2 and N2O groups, respectively. The ED50 of the N2O group was significantly lower than that of the O2 group (P=0.0146). From isotonic regression, 50% effective dose (ED50) (95% CI) of alfentanil in the O2 and N2O groups was 11.4 (9.9–13.0) and 6.5 (5.0–8.1) µg kg–1, respectively.

Conclusions

The effective bolus dose of alfentanil for successful tracheal intubation was 11.5 µg kg–1 in 50% of children during inhalation induction using sevoflurane 5% without neuromuscular blocking agent. Addition of nitrous oxide 60% in oxygen reduced the effective alfentanil dose by 25%.

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