Tracheal intubation in routine practice with and without muscular relaxation: an observational study.
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.
Baillard
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Hôpital Avicenne, APHP, Département d'Anesthésie-Réanimation and SAMU 93-EA 3409, Bobigny Cedex, France. christophe.baillard@avc.ap-hop-paris.fr
Adnet
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Borron
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Racine
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Ait Kaci
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Fournier
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Larmignat
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Cupa
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Samama
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D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001279:Atracurium / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006919:Hydroxyzine / Q000008:administration & dosage; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy; D007830:Larynx / Q000503:physiopathology*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D010146:Pain / Q000209:etiology; D011229:Preanesthetic Medication; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D017409:Sufentanil / Q000008:administration & dosage; D014832:Voice Disorders / Q000209:etiology
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D006919:Hydroxyzine; D017409:Sufentanil; D008874:Midazolam; D015742:Propofol