[Endotracheal intubation without the use of muscle relaxants in patients with myasthenia gravis].
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.
Vlajković
Gordana
G
Klinicki centar Srbije, Beograd, Institut za anesteziju i reanimaciju. gvlaikov@eunet.yu
Sindelić
Radomir
R
Marković
Dejan
D
Terzić
Milica
M
Bumbasirević
Vesna
V
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
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D009465:Neuromuscular Agents; D000077149:Sevoflurane; D005283:Fentanyl; D015742:Propofol