title: Does the timing of tracheal intubation based on neuromuscular monitoring decrease laryngeal injury? A randomized, prospective, controlled trial.
abstract: Vocal cord injuries (VCI) and postoperative hoarseness (PH) are common complications after general anesthesia. Poor muscle relaxation at the moment of tracheal intubation may result in VCI. There is a large interindividual variation in neuromuscular depression after administration of neuromuscular blocking drugs. Therefore, the optimal individual timing of tracheal intubation based on neuromuscular monitoring (monitoring) may decrease VCI. In this prospective trial, 60 patients were randomized into 2 groups: Monitoring group: tracheal intubation at maximum block based on monitoring after atracurium 0.5 mg/kg and 2-min group: tracheal intubation 2 min after injection of atracurium 0.5 mg/kg. Intubating conditions were evaluated with the Copenhagen score. VCI were examined by stroboscopy before and 24 and 72 h after surgery. PH was assessed at 24, 48, and 72 h after surgery by a standardized interview. Excellent intubating conditions were significantly increased in the monitoring group compared with the 2-min group: 8 versus 2 patients, respectively (P = 0.036). The incidence of PH between the study groups was comparable: 7 (monitoring) versus 8 patients (2-min) (P = 0.860). Similar findings were observed for VCI: 9 versus 5 patients; respectively (P = 0.268); type of VCI: thickening of the vocal cords: 8 (monitoring) versus 5 (2-min) patients (P = 0.423), hematomas: 2 patients in each group (not significant). The present study demonstrated that neuromuscular monitoring improved endotracheal intubating conditions. However, tracheal intubation at maximum intensity of neuromuscular block was not associated with a decrease in vocal cord injuries.
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Rostock, Germany. thomas.mencke@uni-rostock.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Mencke
authors.forename: Matthias
authors.initials: M
authors.lastname: Echternach
authors.forename: Peter K
authors.initials: PK
authors.lastname: Plinkert
authors.forename: Ulrich
authors.initials: U
authors.lastname: Johann
authors.forename: Nazan
authors.initials: N
authors.lastname: Afan
authors.forename: Hauke
authors.initials: H
authors.lastname: Rensing
authors.forename: Gabriele
authors.initials: G
authors.lastname: Noeldge-Schomburg
authors.forename: Heike
authors.initials: H
authors.lastname: Knoll
authors.forename: Reinhard
authors.initials: R
authors.lastname: Larsen
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D007818:Laryngeal Diseases / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009469:Neuromuscular Junction / Q000502:physiology*; D011446:Prospective Studies; D013997:Time Factors; D014827:Vocal Cords / Q000473:pathology* / Q000502:physiology*