BJA Advance Access published online on June 15, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem147
Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort
1 Department of Anesthesia, Henri Mondor Hospital (APHP), 51 avenue du Maréchal de Lattre-de-Tassigny, 94100 Créteil cedex, France
2 Department of Anesthesia, Dupuytren Hospital, Limoges, France
* Corresponding author: Service d'anesthésie reanimation, Hôpital Henri-Mondor, 51 avenue du Maréchal de Lattre-de-Tassigny, 94100 Créteil cedex, France. E-mail: xavier.combes{at}hmn.ap-hop-paris.fr
Background: Muscle 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.
Methods: A 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.
Results: Post-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).
Conclusions: The 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.
Keywords: anaesthetic techniques, induction; complications, intubation tracheal; complications, sore throat; pharmacology, rocuronium
Presented as an abstract at the annual meeting of the American Society of Anesthesiologists, San Francisco, October 2003.
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