The intubating laryngeal mask airway: rocuronium improves endotracheal intubating conditions and success rate.
OBJECTIVE
To assess intubating conditions without neuromuscular blocking drugs, to determine the relation between the dose of rocuronium and the probability of achieving excellent or at least good (good or excellent) intubating conditions with the intubating laryngeal mask airway (ILMA), and finally, to determine the relationship between rocuronium use and the success rate of endotracheal intubation.


METHODS
Prospective, randomized, double-blinded, placebo-controlled study.


METHODS
University-affiliated medical center.


METHODS
Sixty American Society of Anesthesiologists physical status I and II patients undergoing elective surgery.


METHODS
Anesthesia was induced with propofol 2.5 mg/kg and fentanyl 1 microg/kg. One minute after loss of consciousness, patients received rocuronium 0.2 mg/kg or saline. In the rocuronium group, if intubating conditions were scored as poor, rocuronium dose in the next patient was increased by 0.05 mg/kg. If intubating conditions were scored as good, no change was made, but if conditions were scored as excellent, the dose was decreased by 0.05 mg/kg. One minute after rocuronium or saline administration, an ILMA was used to intubate the trachea. If intubation was unsuccessful, a second attempt was made using the ILMA.


METHODS
We recorded intubating conditions and the success rate of tracheal intubation.


RESULTS
Without rocuronium, the probability of achieving at least good intubating conditions with the ILMA was 30%. A rocuronium dose of 0.2 mg/kg resulted in a probability of 80% to achieve at least good intubating conditions. Rocuronium significantly increased the success rate of the second intubation attempt.


CONCLUSIONS
To achieve good or excellent intubating conditions with the ILMA, a rocuronium dose lower than the standard intubating dose of 0.6 mg/kg can be used. Neuromuscular blockade increases the success rate of intubation if a second attempt is necessary.
Sastry
Sunita G
SG
Department of Anesthesiology, Stanford University Medical Center, Stanford, CA 94305-5640, USA.
Lemmens
Harry J M
HJ
D000328:Adult; D000732:Androstanols / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007440:Intubation / Q000379:methods; D007442:Intubation, Intratracheal / Q000379:methods*; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D000077123:Rocuronium
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium