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Tracheal intubation in routine practice with and without muscular relaxation: an observational study

Published online by Cambridge University Press:  26 August 2005

C. Baillard ,
F. Adnet ,
S. W. Borron ,
S. X. Racine ,
F. Ait Kaci ,
J. L. Fournier ,
P. Larmignat ,
M. Cupa  and
C. M. Samama
C. Baillard
Affiliation:
Hôpital Avicenne, APHP, Département d'Anesthésie-Réanimation and SAMU 93-EA 3409, Bobigny Cedex, France
F. Adnet
Affiliation:
Hôpital Avicenne, APHP, Département d'Anesthésie-Réanimation and SAMU 93-EA 3409, Bobigny Cedex, France
S. W. Borron
Affiliation:
George Washington University, Department of Emergency Medicine, Washington, DC, USA
S. X. Racine
Affiliation:
Hôpital Avicenne, APHP, Département d'Anesthésie-Réanimation and SAMU 93-EA 3409, Bobigny Cedex, France
F. Ait Kaci
Affiliation:
Hôpital Avicenne, APHP, Département d'Anesthésie-Réanimation and SAMU 93-EA 3409, Bobigny Cedex, France
J. L. Fournier
Affiliation:
Hôpital Avicenne, APHP, Département d'Anesthésie-Réanimation and SAMU 93-EA 3409, Bobigny Cedex, France
P. Larmignat
Affiliation:
Hôpital Avicenne, APHP, Département d'Anesthésie-Réanimation and SAMU 93-EA 3409, Bobigny Cedex, France
M. Cupa
Affiliation:
Hôpital Avicenne, APHP, Département d'Anesthésie-Réanimation and SAMU 93-EA 3409, Bobigny Cedex, France
C. M. Samama
Affiliation:
Hôpital Avicenne, APHP, Département d'Anesthésie-Réanimation and SAMU 93-EA 3409, Bobigny Cedex, France
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Extract

Summary

Background and objective: The ease of endotracheal intubation has been recently shown to affect the incidence of laryngeal injury. There remains controversy as to whether or not a muscle relaxant is routinely required for tracheal intubation. This study examined conditions of intubation in our routine practice, which employs a relaxant-sparing approach. Methods: All adult patients scheduled for surgery with general anaesthesia were prospectively included. A muscle relaxant was used to facilitate intubation when it was required for the surgical procedure and/or otherwise regarded as necessary by the anaesthesiologist. In the remaining patients, a relaxant-free intubation was performed. Intubating conditions were evaluated in all the patients as well as the post-intubation laryngeal symptoms. Results: Between March and July 2003, 612 patients were consecutively included. A muscle relaxant was used in 32% of patients and no relaxant in the remaining patients (68%). Clinically acceptable intubating scores were observed in 98.4% overall with no significant difference between the two groups. Excellent conditions occurred more frequently in the relaxant group as compared to the relaxant-free group, 87% vs. 72%, P = 0.005. Laryngeal symptoms occurred in 184 (33%) patients with no difference between the two groups. Conclusions: Our relaxant-sparing approach did not increase the incidence of poor conditions of intubation nor laryngeal symptoms. However, excellent conditions occurred more frequently in the relaxant group. A more flexible approach to the issue of the need for neuromuscular blockade prior to intubation is proposed.

Keywords

INTUBATION, INTRATRACHEAL, intubating conditions, adverse effectsANAESTHESIA, GENERALNEUROMUSCULAR BLOCKING AGENTSPROPOFOL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 9 , September 2005 , pp. 672 - 677
Copyright
© 2005 European Society of Anaesthesiology

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References

Domino KB, Posner KL, Caplan RA, Cheney FW. Airway injury during anaesthesia: a closed claims analysis. Anesthesiology 1999; 91: 1703–1711.Google Scholar
Mencke T, Echternach M, Kleinschmidt S et al. Laryngeal morbidity and quality of tracheal intubation: a randomised controlled trial. Anesthesiology 2003; 98: 1049–1056.Google Scholar
Maktabi MA, Smith RB, Todd MM. Is routine endotracheal intubation as safe as we think or wish? Anesthesiology 2003; 99: 247–248.Google Scholar
Mertes PM, Laxenaire MC, Alla F. Groupe d'Etudes des Reactions Anaphylactoides Peranesthesiques. Anaphylactic and anaphylactoid reactions occurring during anaesthesia in France in 1999–2000. Anesthesiology 2003; 99: 536–545.Google Scholar
Laxenaire MC, Auroy Y, Clergue F, Péquignot F, Jougla E, Lienhart A. Organization and techniques of anesthesia. Ann Fr Anesth Réanim 1998; 17: 1317–1323.Google Scholar
Adnet F, Baillard C, Borron SW et al. Randomized study comparing the ‘sniffing position’ with simple head extension for laryngoscopic view in elective surgery patients. Anesthesiology 2001; 95: 836–841.Google Scholar
Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105–1111.Google Scholar
Viby-Mogensen J, Engbaek J, Eriksson LI et al. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand 1996; 40: 59–74.Google Scholar
Consensus conference: Indications for curarization in anaesthesia. Saint-Mande, 8 July 1999. Proceedings. Ann Fr Anesth Reanim 2000; 19 (Suppl 2): 344s–472s.
Lieutaud T, Billard V, Khalaf H, Debaene B. Muscle relaxation and increasing doses of propofol improve intubating conditions. Can J Anaesth 2003; 50: 121–126.Google Scholar
Adachi YU, Uchihashi Y, Watanabe K, Satoh T. Small dose midazolam or droperidol reduces the hypnotic dose of propofol at the induction of anaesthesia. Eur J Anaesthesiol 2000; 17: 126–131.Google Scholar
Bulow K, Nielsen TG, Lund J. The effect of topical lignocaine on intubating conditions after propofol-alfentanil induction. Acta Anaesthesiol Scand 1996; 40: 752–756.Google Scholar
Billard V, Moulla F, Bourgain JL, Megnigbeto A, Stanski DR. Hemodynamic response to induction and intubation. Propofol/fentanyl interaction. Anesthesiology 1994; 81: 1384–1393.Google Scholar
Naguib M, Samarkandi A, Riad W, Alharby SW. Optimal dose of succinylcholine revisited. Anesthesiology 2003; 99: 1045–1049.Google Scholar
Jones MW, Catling S, Evans E, Green DH, Green JR. Hoarseness after tracheal intubation. Anaesthesia 1992; 47: 213–216.Google Scholar