Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study.
OBJECTIVE
The need for muscular relaxation to improve intubating conditions and to reduce the incidence of laryngeal morbidity is still controversial. The aim of this study was to determine the incidence of symptomatic laryngeal injuries (SLI) and of acceptable intubating conditions (including both good and excellent conditions), both with and without cisatracurium during induction of anesthesia, along with moderate doses of remifentanil and propofol.


METHODS
In this prospective, randomized double-blind equivalence trial, the intubating conditions were compared in 130 ASA I or II female patients. All subjects received remifentanil 2 microg x kg(-1) i.v. and propofol 2.5 mg x kg(-1) i.v., with either cisatracurium 0.15 mg x kg(-1) i.v. (group Cisatracturium), or saline (group Placebo). Tracheal intubating conditions were assessed with the Copenhagen Score. A systematic screening for postoperative hoarseness and sore throat was performed 24 and 48 hr after anesthesia, followed by a nasofibroscopic examination when laryngeal symptoms persisted at 48 hr.


RESULTS
Twenty-four hr after anesthesia, the incidence of postoperative hoarseness and sore throat in the Cisatracurium and Placebo groups was 26.5% and 21.5%, respectively, and 48 hr after anesthesia, the incidence was 7.8% and 6.1%, respectively (P = 0.32 and P = 0.50 between groups, respectively). In the clinically evaluable population, the incidence of SLI, assessed at 48 hr by nasofibroscopy, was equivalent in both groups, 1.6% vs 1.5% in group Placebo and group Cisatracurium, respectively (P < 0.001 for equivalence test), as was the occurrence of acceptable intubating conditions (95.4% vs 100%, P < 0.05 for equivalence test). However, the occurrence of excellent intubating conditions was more frequent in group Cisatracurium than in group Placebo (P = 0.0003).


CONCLUSIONS
Following induction of anesthesia with propofol and moderate-dose remifentanil, cisatracurium did not confer a higher rate of good-to-excellent conditions for tracheal intubation, nor did muscle relaxation with cisatracurium decrease the rate of SLI after tracheal intubation.
Department of Anesthesia and Intensive Care, Edouard Herriot Hospital, Claude Bernard Lyon 1 University of Lyon, Lyon, France. lionel.bouvet@chu-lyon.fr
Lionel
L
Bouvet
Alina
A
Stoian
Sophie
S
Jacquot-Laperrière
Bernard
B
Allaouchiche
Dominique
D
Chassard
Emmanuel
E
Boselli
D000328:Adult; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001279:Atracurium / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods*; D007830:Larynx / Q000187:drug effects / Q000293:injuries*; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D010612:Pharyngitis / Q000209:etiology; D010880:Piperidines / Q000008:administration & dosage; D011183:Postoperative Complications / Q000209:etiology; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D000077208:Remifentanil; D012965:Sodium Chloride / Q000008:administration & dosage; D013997:Time Factors
D018686:Anesthetics, Intravenous; D009466:Neuromuscular Blocking Agents; D010880:Piperidines; D001279:Atracurium; D012965:Sodium Chloride; D000077208:Remifentanil; C101584:cisatracurium; D015742:Propofol