title: Tracheal intubation in routine practice with and without muscular relaxation: an observational study.
abstract: 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.
authors.affiliation: Hôpital Avicenne, APHP, Département d'Anesthésie-Réanimation and SAMU 93-EA 3409, Bobigny Cedex, France. christophe.baillard@avc.ap-hop-paris.fr
authors.forename: C
authors.initials: C
authors.lastname: Baillard
authors.forename: F
authors.initials: F
authors.lastname: Adnet
authors.forename: S W
authors.initials: SW
authors.lastname: Borron
authors.forename: S X
authors.initials: SX
authors.lastname: Racine
authors.forename: F
authors.initials: F
authors.lastname: Ait Kaci
authors.forename: J L
authors.initials: JL
authors.lastname: Fournier
authors.forename: P
authors.initials: P
authors.lastname: Larmignat
authors.forename: M
authors.initials: M
authors.lastname: Cupa
authors.forename: C M
authors.initials: CM
authors.lastname: Samama
mesh_terms: 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
chemical_list: D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D006919:Hydroxyzine; D017409:Sufentanil; D008874:Midazolam; D015742:Propofol