Dose-Response of Propofol for Tracheal Intubation in Children Correlated to Intubation Condition Score and Cerebral State Index. Randomized, Double-Blinded Trial

AbstractBackground: Avoiding neuromuscular blocking drugs may prevent the potential complications of their use ifthey are not required for the planned procedure. This study was designed to estimate dose-response of propofolfor tracheal intubation in children correlated to Intubation Condition Score and Cerebral State Index (CSI) withoutneuromuscular blocking drugs.Methods: 56 children (ages 3-8 years), ASA physical status I and II, weight 13-35 Kg, admitted for adenotonsillectomywere included. Children were randomly divided into four groups to receive propofol by Target ControlledInfusion (TCI) at different concentrations: 3.0 μg•ml-1, 3.5 μg•ml-1, 4.0 μg•ml-1, 4.5 μg•ml-1. At time T0 remifentanilinfusion 0.5 μg•kg-1•min-1 was started. After 4 min, time T1, children received propofol according to their group. Attime T2 (8 min after T0) tracheal intubation was carried out, Intubation Condition Score and CSI values at time T2were assessed.Results: The results show that increasing propofol plasma concentrations from 3.0 μg•ml-1 to 4.5 μg•ml-1, thenumber of patients with acceptable intubating conditions, increased to 100%. There was a statistically significantdifference with respect to Intubating Condition Score: 3.0 μg•ml-1 vs 4.5 μg•ml-1 and 3.0 μg•ml-1 vs 4.0 μg•ml-1. Withreference to CSI values, a statistically significant difference was observed between 4.5 μg•ml-1 and the other 3concentrations. We observed a significant difference in patients with CSI≤50 versus CSI>50 among the four propofolgroups. Therefore, we detected a significant difference in the Intubation Condition Score between the CSI≤50 andCSI>50 groups.Conclusions: The administration of propofol at 4 and 4.5 μg•ml-1, coadministered with remifentanil 0.5 μg•kg-1•min-1,provided clinically acceptable conditions for tracheal intubation. In our opinion the use of CSI monitoring may be ofpractical value in producing acceptable intubating conditions in children.