title: [Endotracheal intubation without the use of muscle relaxants in patients with myasthenia gravis].
abstract: BACKGROUND
  Although muscle relaxants have been widely used to facilitate endotracheal intubation, the administration of these drugs in myasthenic patients may be associated with adverse events.
  
  
  METHODS
  After obtaining Institutional Reviewing Board approval and informed, patient consent, 30 patients with myasthenia gravis were enrolled in a prospective, double-blind, randomized clinical trial. We compared intubating conditions (ease of laryngoscopy, vocal cords, cough, jaw relaxation, limb movement) following fentanyl 2 mg/kg and propofol 2 mg/kg (group PRO, n = 15) vs fentanyl 2 mg/kg and sevoflurane 5% in a 1:2 mixture of oxygen and nitrous oxide (group SEVO, n = 15). The statistical analysis was performed using Student's t test and Chi-quadrate test, p < 0.05 being regarded as significant.
  
  
  RESULTS
  The overall intubating conditions were excellent in 67% of patients in the group PRO vs 80% of patients in the group SEVO (p > 0.05). One patient in each group had clinically unacceptable conditions for intubation. The mean intubation score was 5.7 +/- 1.0 in the group PRO vs 5.9 +/- 0.9 in the group SEVO (p > 0.05). Three patients receiving propofol and one patient receiving sevoflurane had mild hoarseness after the surgery (p > 0.05).
  
  
  CONCLUSIONS
  Both propofol and sevoflurane, supplemented with fentanyl, provide good intubating conditions without the use of muscle relaxants in patients with myasthenia gravis.
authors.affiliation: Klinicki centar Srbije, Beograd, Institut za anesteziju i reanimaciju. gvlaikov@eunet.yu
authors.forename: Gordana
authors.initials: G
authors.lastname: Vlajković
authors.forename: Radomir
authors.initials: R
authors.lastname: Sindelić
authors.forename: Dejan
authors.initials: D
authors.lastname: Marković
authors.forename: Milica
authors.initials: M
authors.lastname: Terzić
authors.forename: Vesna
authors.initials: V
authors.lastname: Bumbasirević
mesh_terms: D000328:Adult; D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008738:Methyl Ethers; D009157:Myasthenia Gravis / Q000601:surgery*; D009465:Neuromuscular Agents; D015742:Propofol; D000077149:Sevoflurane; D013934:Thymectomy
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D009465:Neuromuscular Agents; D000077149:Sevoflurane; D005283:Fentanyl; D015742:Propofol