To study the adequacy of surgical muscle relaxation in paediatric patients scheduled for elective groin surgeries under general anesthesia using sevoflurane without using neuromuscular blocking agents

Abstract

Abstract

Introduction:  In Anesthesia practice neuromuscular blocking agents (muscle relaxants) are used for intubation and surgical muscle relaxation. The use of modern inhalational anesthetics like sevoflurane is commonly practiced in paediatric anesthesia for induction and endotracheal intubation. LMA is alternative to endotracheal intubation. It is commonly used supraglotic device for the elective surgical procedures in adults and paediatric population. We conducted this study to see whether sevoflurane produces enough surgical muscle relaxation so that the use of neuromuscular blocking agents can be avoided.

Patients and Methods:  84 paediatric patients of King Khalid Hospital (KSA) from April 2013 to February 2014 posted for elective surgical procedure were included in this observational study regarding the adequacy of surgical muscle relaxation.  Induction of anesthesia was done with propofol 2mg/kg and Fentanyl 2 mcg/ kg. Airway was maintained with LMA. Anesthesia was maintained by sevoflurane in oxygen and air. Blood pressure and Heart rate was kept with 20% of baseline reading. Adequacy of surgical muscle relaxation was asked by the surgeon during surgery and was graded as good, fair or poor.

Results:  Mean age of the patients was 2.4 year. There were 76 male and 8 female patients. 47 patients were operated for inguinal herniotomy, 32 for orchedopexy and 5 for umbilical herniotomy. Surgical muscle relax-ation was good in all of the patients and none of them required use of muscle relaxants. Recovery of all patients was smooth.

Discussion:  Adequate surgical muscle relaxation is important to facilitate surgery. In paediatric population sevoflurane produces enough muscle relaxation for intubation and surgical muscle relaxation. Monitoring of muscle relaxation can be clinical as well as through muscle twitches.

Conclusion:  Our study showed that in paediatric population the elective surgical procedures of groin region can be done without using muscle relaxants.

Keywords:  Paediatric anesthesia, LMA, neuromuscular blocking agents, surgical muscle relaxation.