Comparison of intubating conditions with propofol- suxamethonium versus propofol-lidocaine in pediatric patients aged 3 – 16 years old undergoing elective surgery: A randomized, double-blinded controlled trial

Abstract

Abstract Introduction: Suxamethonium, a depolarizing muscle relaxant, offers rapid onset and optimal intubating conditions. However, due to its adverse effects, researchers have sought safer alternatives. Propofol alone provides adequate but suboptimal intubation conditions, while studies suggest that combining intravenous lidocaine with propofol may improve outcomes. Therefor; this study aims to compared tracheal intubation conditions and ease between two regimens: propofol with suxamethonium (PS) versus propofol-lidocaine (PL). Materials and Methods: A prospective, randomized, double-blinded controlled trial was performed after ethical approval from the St. Paul Specialized Hospital institutional review board (IRB). Ninety-two eligible patients (aged 3 - 16 years) was randomized into PS (2 mg/kg propofol + 1.5 mg/kg suxamethonium) or PL (2 mg/kg propofol + 1.5 mg/kg IV lidocaine) groups. Intubating conditions were assessed using a 0–6 scale evaluating jaw relaxation, intubation ease, and reflex response. Scores were categorized as: Good (5–6), Moderate (3–4), and Poor (0–2). Results: this study revealed that 95.7% of the patients in the PS group achieved good intubating conditions and 100% successful intubation. In contrast, the PL group demonstrated moderate intubating conditions in 56.5% and poor conditions in 43.5% of patients. The overall intubation success rate in the PL group was 73.9%, with a 26.1% failure rate. Conclusion: Although propofol and lidocaine can facilitate laryngoscopy and tracheal intubation without suxamethonium, the combination is associated with a significantly lower success rate and less favorable intubating conditions compared to propofol-suxamethonium. Keywords: Endotracheal intubation, Propofol, Lidocaine, Suxamethonium, Opioids, Ethiopia