title: Comparison of four facial muscles, orbicularis oculi, corrugator supercilii, masseter or mylohyoid, as best predictor of good conditions for intubation: a randomised blinded trial.
abstract: BACKGROUND
  Monitoring of facial muscles after neuromuscular blockade can give an early indication of respiratory muscle readiness for tracheal intubation.
  
  
  OBJECTIVE
  To assess which facial muscle, the orbicularis oculi, corrugator supercilii, masseter or the mylohyoid, is the best predictor of readiness for intubation after rocuronium.
  
  
  METHODS
  Prospective, randomised, blinded trial.
  
  
  METHODS
  Single centre: Seoul, Korea, from August 2012 to November 2012.
  
  
  METHODS
  Two hundred and eighty-eight patients aged 22 to 64 years were randomised to one of eight study groups: orbicularis oculi, corrugator supercilii, masseter and mylohyoid for rocuronium 0.6 or 1.2 mg kg.
  
  
  METHODS
  The maximum twitch depression at the eyelid (orbicularis oculi), the superciliary arch (corrugator supercilii), the cheek (masseter) and the submental triangle (mylohyoid) was assessed after rocuronium 0.6 and 1.2 mg kg. Endotracheal intubation was performed after maximal neuromuscular blockade, and intubating conditions were appraised.
  
  
  METHODS
  The onset time of rocuronium and the quality of the intubation conditions were assessed.
  
  
  RESULTS
  The onset times in the orbicularis oculi, corrugator supercilii and masseter were significantly faster than that in the mylohyoid (P < 0.001). 'Clinically acceptable' intubation conditions were significantly enhanced in the mylohyoid (94%) compared with those in the orbicularis oculi (80%) and masseter (78%) after rocuronium 0.6 mg kg (P < 0.05), and no difference with corrugator supercilii (92%). Despite differences in onset time of orbicularis oculi and masseter compared to mylohyoid (P < 0.05), intubating conditions were similar among the four muscles after rocuronium 1.2 mg kg.
  
  
  CONCLUSIONS
  Following rocuronium 0.6 mg kg at similar depths of anaesthesia, the monitoring of the corrugator supercilii provided the best balance of a shorter onset time while maintaining 'clinically acceptable' intubation conditions.
  
  
  BACKGROUND
  IRB File No.: HYUH 2012-07-009.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Hanyang University Hospital, Seoul, Republic of Korea.
authors.forename: Hee J
authors.initials: HJ
authors.lastname: Lee
authors.forename: Kyo S
authors.initials: KS
authors.lastname: Kim
authors.forename: Ji S
authors.initials: JS
authors.lastname: Jeong
authors.forename: Jae C
authors.initials: JC
authors.lastname: Shim
authors.forename: You N
authors.initials: YN
authors.lastname: Oh
mesh_terms: D000328:Adult; D000732:Androstanols / Q000494:pharmacology*; D005152:Facial Muscles / Q000502:physiology*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D019148:Neuromuscular Blockade; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology*; D011446:Prospective Studies; D000077123:Rocuronium
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D000077123:Rocuronium