The avoidance of neuromuscular paralysis in outpatients requiring endotracheal intubation temporarily increases the incidence of postoperative laryngeal symptoms: quasi-experimental study
Abstract
Introduction. Endotracheal intubation without neuromuscular relaxation has become more common, but its impact on surgical units of teaching hospitals is unknown.
Objective. To assess the impact of avoiding neuromuscular relaxation in terms of incidence of hoarseness and sore throat in ambulatory surgery patients requiring endotracheal intubation in surgical unit of a teaching hospital.
Method. A quasi-experimental, non-randomized, double-blind study in adult patients undergoing outpatient surgery requiring endotracheal intubation. The non muscle relaxant group received lidocaine (1.5 mg kg-1), propofol (1.5 - 2 mg kg-1) and remifentanil 4 mcg *kg-1 and the muscle relaxation group received the same technique and rocuronium 0.3 to 0.6 mg *kg-1. The primary outcomes were assessed at days 1, 3 and 14.
Results. We enrolled 287patients, where 51.7 % received rocuronium. The incidence of hoarseness was significantly higher at 24 hours in the nonrelaxant group (26 % vs. 15 %, p value: 0.016) being not significant after 72 hours of follow up (0.6 % vs. 0 %; p: 0.37). We found no differences in the incidence of sore throat between the groups. All the study patients were asymptomatic at one week.
Conclusions. Avoidance of neuromuscular relaxation is associated with a transient (First 24 hours) increase in hoarseness after ambulatory surgery, but no difference in sore throat. We found no differences in the incidence of laryngeal symptoms after 72 hours. The addition of muscle relaxant to reduce the incidence of hoarseness can be justified.
Keywords: Intratracheal intubation, general anesthesia, adverse effects, methods, postoperative complications (Source: MeSH, NLM).
References
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