Comparison Study for Vocal Cords Conditions for Intubation between Cisatracurium and Sevoflurane in Patient Undergoing Gynecological Surgery

Abstract

Background: Intravenous induction (IV) followed by tracheal intubation using Neuromuscular blocking agent (NMB) during general anesthesia is a common practice in modern anesthesia. Avoidance of NMB is concerned in anticipated difficult airway or difficult IV access. Sevoflurane is an agent of choice for inhalation induction. Its gradual deepening of anesthesia and return of muscle tone when lightening.
Objective: To exam the conditions of vocal cords for endotracheal intubation by sevoflurane without the NMB agent compared to those by cisatracurium.
Methods: This prospective double blind control study. Randomly allocated 124 patients and divided into 2 groups; Group M (cisatracurium) and Group V (sevoflurane). In both groups premedication with Fentanyl and Midazolam then preoxygenated by 3 minutes. Anesthesia was induced with 8% sevoflurane N2O 4 LPM, O2 2 LPM. Spontaneous breathing until loss of eye rash reflex. Group M; the sevoflurane was closed then a bolus dose of cisatracurium 0.15 mg/kg IV and control ventilation 3 minute. Group V; controlled ventilation was continuously extended from the induction phase for 3 minutes and then each patient from each group was endotracheal intubated similarly by a nurse anesthetist.
Result: In the non-inferior analysis, Comparing vocal cord conditions Group V with Group M, opened and standing was 90.32% VS 83.87% (95%CI, P<0.03) . Incidence of hypotension before intubation (Proportion test) was 66.13% in group V and 50% in group M (95%CI, P=0.07)
Conclusion: Sevoflurane offers a smooth technique for induction and intubation non-inferiorly to intubation with neuromuscular blocking agent.