• Br J Anaesth · Aug 2007

    Randomized Controlled Trial Comparative Study

    Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort.

    Intubation without muscle relaxant is associated with greater incidence of sore throat, hoarseness, hypotension, bradycardia and intubation difficulty.

    pearl
    • X Combes, L Andriamifidy, E Dufresne, P Suen, S Sauvat, E Scherrer, P Feiss, J Marty, and P Duvaldestin.
    • Department of Anesthesia, Henri Mondor Hospital (APHP), 51 avenue du Maréchal de Lattre-de-Tassigny, 94100 Créteil cedex, France. xavier.combes@hmn.ap-hop-paris.fr
    • Br J Anaesth. 2007 Aug 1;99(2):276-81.

    BackgroundMuscle relaxants facilitate tracheal intubation, but they are often not used for short peripheral surgical procedures. The consequences of this practice on the upper airway are still a matter of controversy. We therefore compared the incidence of post-intubation symptoms in a randomized study comparing patients intubated with or without the use of a muscle relaxant.MethodsA total of 300 adult patients requiring tracheal intubation for scheduled peripheral surgery were randomly assigned in a double-blind study to an anaesthetic protocol that either included or did not include a muscle relaxant (rocuronium). The primary end-point was the rate of post-intubation symptoms 2 and 24 h after extubation. The secondary end-points were the intubation conditions score (Copenhagen Consensus Conference), the rate of difficult intubations (Intubation Difficulty Scale), and the incidence of adverse haemodynamic events.ResultsPost-intubation symptoms were more frequent in patients intubated without the use of a muscle relaxant, whether 2 h (57% vs 43% of patients; P < 0.05) or 24 h (38% vs 26% of patients; P < 0.05) after extubation. Intubation conditions were better when the muscle relaxant was used. In patients intubated without a muscle relaxant, difficult intubation was more common (12% vs 1%; P < 0.05), as were arterial hypotension or bradycardia requiring treatment (12% vs 3% of patients; P < 0.05).ConclusionsThe use of a muscle relaxant for tracheal intubation diminishes the incidence of adverse postoperative upper airway symptoms, results in better tracheal intubation conditions, and reduces the rate of adverse haemodynamic events.

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    This article appears in the collection: Neuromuscular myths: the lies we tell ourselves.

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    pearl
    1

    Intubation without muscle relaxant is associated with greater incidence of sore throat, hoarseness, hypotension, bradycardia and intubation difficulty.

    Daniel Jolley  Daniel Jolley
    summary
    0

    Researchers compared induction with propofol (2.5 mg/kg), alfentanil (15 µg/kg) and rocuronium (0.6 mg/kg) to using propofol (2.5 mg/kg) and alfentanil (40 µg/kg) alone. Patients who did not receive muscle relaxants experienced more sore throat and hoarseness, more hypotension and bradycardia and a 10 times greater incidence of intubation difficulty.

    Daniel Jolley  Daniel Jolley
     
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