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Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study.
Can J Anaesth. 2008 Oct; 55(10):674-84.CJ

Abstract

PURPOSE

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).

CONCLUSION

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.

Authors+Show Affiliations

Department of Anesthesia and Intensive Care, Edouard Herriot Hospital, Claude Bernard Lyon 1 University of Lyon, Lyon, France. lionel.bouvet@chu-lyon.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18835965

Citation

Bouvet, Lionel, et al. "Laryngeal Injuries and Intubating Conditions With or Without Muscular Relaxation: an Equivalence Study." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, vol. 55, no. 10, 2008, pp. 674-84.
Bouvet L, Stoian A, Jacquot-Laperrière S, et al. Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study. Can J Anaesth. 2008;55(10):674-84.
Bouvet, L., Stoian, A., Jacquot-Laperrière, S., Allaouchiche, B., Chassard, D., & Boselli, E. (2008). Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 55(10), 674-84. https://doi.org/10.1007/BF03017743
Bouvet L, et al. Laryngeal Injuries and Intubating Conditions With or Without Muscular Relaxation: an Equivalence Study. Can J Anaesth. 2008;55(10):674-84. PubMed PMID: 18835965.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study. AU - Bouvet,Lionel, AU - Stoian,Alina, AU - Jacquot-Laperrière,Sophie, AU - Allaouchiche,Bernard, AU - Chassard,Dominique, AU - Boselli,Emmanuel, PY - 2008/10/7/pubmed PY - 2009/1/15/medline PY - 2008/10/7/entrez SP - 674 EP - 84 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 55 IS - 10 N2 - PURPOSE: 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). CONCLUSION: 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. SN - 0832-610X UR - https://www.unboundmedicine.com/medline/citation/18835965/Laryngeal_injuries_and_intubating_conditions_with_or_without_muscular_relaxation:_an_equivalence_study_ L2 - https://doi.org/10.1007/BF03017743 DB - PRIME DP - Unbound Medicine ER -