title: Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort.
abstract: BACKGROUND
  Muscle relaxants facilitate tracheal intubation, but they are often not used for short peripheral surgical procedures. The consequences of this practice on the upper airway are still a matter of controversy. We therefore compared the incidence of post-intubation symptoms in a randomized study comparing patients intubated with or without the use of a muscle relaxant.
  
  
  METHODS
  A total of 300 adult patients requiring tracheal intubation for scheduled peripheral surgery were randomly assigned in a double-blind study to an anaesthetic protocol that either included or did not include a muscle relaxant (rocuronium). The primary end-point was the rate of post-intubation symptoms 2 and 24 h after extubation. The secondary end-points were the intubation conditions score (Copenhagen Consensus Conference), the rate of difficult intubations (Intubation Difficulty Scale), and the incidence of adverse haemodynamic events.
  
  
  RESULTS
  Post-intubation symptoms were more frequent in patients intubated without the use of a muscle relaxant, whether 2 h (57% vs 43% of patients; P < 0.05) or 24 h (38% vs 26% of patients; P < 0.05) after extubation. Intubation conditions were better when the muscle relaxant was used. In patients intubated without a muscle relaxant, difficult intubation was more common (12% vs 1%; P < 0.05), as were arterial hypotension or bradycardia requiring treatment (12% vs 3% of patients; P < 0.05).
  
  
  CONCLUSIONS
  The use of a muscle relaxant for tracheal intubation diminishes the incidence of adverse postoperative upper airway symptoms, results in better tracheal intubation conditions, and reduces the rate of adverse haemodynamic events.
authors.affiliation: Department of Anesthesia, Henri Mondor Hospital (APHP), 51 avenue du Maréchal de Lattre-de-Tassigny, 94100 Créteil cedex, France. xavier.combes@hmn.ap-hop-paris.fr
authors.forename: X
authors.initials: X
authors.lastname: Combes
authors.forename: L
authors.initials: L
authors.lastname: Andriamifidy
authors.forename: E
authors.initials: E
authors.lastname: Dufresne
authors.forename: P
authors.initials: P
authors.lastname: Suen
authors.forename: S
authors.initials: S
authors.lastname: Sauvat
authors.forename: E
authors.initials: E
authors.lastname: Scherrer
authors.forename: P
authors.initials: P
authors.lastname: Feiss
authors.forename: J
authors.initials: J
authors.lastname: Marty
authors.forename: P
authors.initials: P
authors.lastname: Duvaldestin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000732:Androstanols; D001794:Blood Pressure; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents; D010612:Pharyngitis / Q000209:etiology*; D011183:Postoperative Complications; D011446:Prospective Studies; D000077123:Rocuronium
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium