SURGICAL MUSCLE RELAXATION

TO STUDY THE ADEQUACY IN PAEDIATRIC PATIENTS SCHEDULED FOR ELECTIVE GROIN SURGERIES UNDER GENERAL ANESTHESIA USING SEVOFLURANE WITHOUT NEUROMUSCULAR BLOCKING AGENTS.

Abstract

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 (Laryngeal Mask Airway) 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. Study
Design: Observational study. Setting: King Khalid Hospital (KSA). Period: April 2013 to
February 2014. Material and Methods: 84 paediatric patients posted for elective surgical
procedure were included. 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
relaxation 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