• J M Devys, G Mourissoux, F X Donnette, R Plat, F Schauvliège, P Le Bigot, P Dureau, and B Plaud.
• Department of Anaesthesia and Critical Care, Fondation Ophtalmologique Adolphe de Rothschild, 25–29 rue Manin, 75019 Paris, France. jmdevys@fo-rothschild.fr
• Br J Anaesth. 2011 Feb 1;106(2):225-9.

BackgroundThe aim of this study was to compare intubating conditions and adverse events after sevoflurane induction in infants, with or without the use of rocuronium or alfentanil.MethodsSeventy-five infants, aged 1-24 months, undergoing elective surgery under general anaesthesia were randomly assigned to receive 8% sevoflurane with either placebo (i.v. saline 0.5 ml kg⁻¹), rocuronium (0.3 mg kg⁻¹), or alfentanil (20 µg kg⁻¹). The primary outcome measure was intubating conditions evaluated 90 s after test drug injection by an anaesthetist unaware of the patient's group. The secondary outcome criteria were respiratory (Sp(O₂) <90%, laryngospasm, closed vocal cords preventing intubation, bronchospasm) and haemodynamic adverse events (heart rate and mean arterial pressure variations ≥30% control value).ResultsIntubating conditions were significantly better in the rocuronium group, with clinically acceptable intubating conditions in 92%, vs 70% in the alfentanil group and 63% in the placebo group (P=0.044). Adverse respiratory events were significantly less frequent in the rocuronium group: 0% vs 33% in the placebo group and 30% in the alfentanil group (P=0.006). Haemodynamic adverse events were more frequent in the alfentanil group: 48% vs 7% in the placebo group and 16% in the rocuronium group (P=0.0019).ConclusionsIn 1- to 24-month-old infants, the addition of 0.3 mg kg⁻¹ rocuronium to 8% sevoflurane improved intubating conditions and decreased the frequency of respiratory adverse events. Alfentanil provided no additional benefit in this study.

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