The comparison of airway management in modified rapid sequence induction method versus awake-sedated intubation in infants with intestinal obstruction

Abstract

Various intubation methods can be designed for infants with bowel obstruction candidate for surgery. Airway management problems during anesthesia of infants with intestinal obstruction are not only related to the nature of the disease but also to the features of the airway in this age group. Decreased level of consciousness and relaxation resulting from anesthesia induction causes the tongue and pharyngeal soft tissue to collapse into the airway. Therefore, the aim of the present study was to compare airway management in modified rapid induction methods and awake intubation after receiving sedation in infants with intestinal obstruction. Materials and Methods: In this cross-sectional study, 50 vigorous children (high physical strength and high muscle tone) with from intestinal obstruction requiring surgery were enrolled and randomly allocated in one of two groups of A (awake intubation) or R (modified RSI). In both groups, fentanyl (1 mcg/kg), midazolam (0.03 ml/kg) and atropine (20 mcg/kg) were injected. In group A, an IV lidocaine (1 mg/kg) was injected one minute before orotracheal intubation, and after completion of a three-minute period of pre-oxygenation, intubation was performed. In the group R, first induction drugs including lidocaine (1 mg/kg), propofol (3 mg/kg) and atracurium (0.5 mg/kg) were IV injected and after 30-60 seconds intubation were performed. In this time, ventilation is done with the bag and the face mask under the airway pressure equal to 10 cmH2O. Results: Volume of stomach content during suction, the severity of abdominal distention after an intubation, the number of attempts to intubation and the time of the intubation did not differ significantly between the two groups (P>0.05). In the present study, there was no significant difference between the hemodynamic variables between the two groups (P>0.05). Also, the results of this study showed that in evaluating the incidence of post-intubation complications, the incidence of stomach distention in the R group and the emergence rate of bucking in group A was higher (respectively, p=0.025 and p=0.001).