The avoidance of neuromuscular paralysis in outpatients requiring endotracheal intubation temporarily increases the incidence of postoperative laryngeal symptoms: quasi-experimental study
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).
2.Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, Fuchs-Buder T. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiol. 2003;98(5): 1049-56.
3.Higgins PP, Chung F, Mezei G. Postoperative sore throat after ambulatory surgery. Br J Anaesth. 2002;88(4):582-4.
4.Al-Qahtani AS, Messahel FM. Quality improvement in anesthetic practice-incidence of sore throat after using small tracheal tube. Middle East J Anesthesiol. 2005;18(1):179-83.
5.Woods AW, Allam S. Tracheal intubation without the use of neuromuscular blocking agents. Br J Anaesth. 2005;94(2):150-8.
6.Baillard C, Adnet F, Borron SW, Racine SX, Ait Kaci F, Fournier JL, Larmignat P, Cupa M, Samama CM. Tracheal intubation in routine practice with and without muscular relaxation: an observational study. Eur J Anaesthesiol. 2005;22(9):672-7.
7.Grant S, Noble S, Woods A, Murdoch J, Davidson A. Assessment of intubating conditions in adults after induction with propofol and varying doses of remifentanil. Br J Anaesth. 1998;81(4):540-3.
8.Ding Y, Fredman B, White PF. Use of mivacurium during laparoscopic surgery:effect of reversal drugs on postoperative recovery. Anesth Analg.1994;78(3):450-4.
9.Mertes PM, Laxenaire MC, Alla F; Groupe d'Etudes des Réactions Anaphylactoi'des Peranesthésiques. Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999-2000. Anesthesiology. 2003;99(3):536-45.
10.Debaene B, Plaud B, Dilly MP, Donati F. Residual paralysis in the PACU after a single intubating dose of nondepolarizing muscle relaxant with an intermediate duration of action. Anesthesiology. 2003;98(5): 1042-8.
11.Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants. Anesth Analg. 1998;86(1):45-9.
12.Klemola UM, Mennander S, Saarnivaara L. Tracheal intubation without the use of muscle relaxants: remifentanil or alfentanil in combination with propofol. Acta Anaesthesiol Scand. 2000;44(4):465-9.
13.Alexander R, Olufolabi AJ, Booth J, El-Moalem HE, Glass PS. Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants. Anaesthesia. 1999;54(11):1037-40.
14.Schlaich N, Mertzlufft F, Soltész S, Fuchs-Buder T. Remifentanil and propofol without muscle relaxants or with different doses of rocuronium for tracheal intubation in outpatient anaesthesia. Acta Anaesthesiol Scand. 2000;44(6):720-6.
15.Pocock SJ, Hughes MD. Estimation issues in clinical trials and overviews. Stat Med. 1990;9(6):657-71.
16.Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39(11):1105-11.
17.Combes X, Andriamifidy L, Dufresne E, Suen P, Sauvat S, Scherrer E, Feiss P, Marty J, Duvaldestin P. Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort. Br J Anaesth. 2007;99(2):276-81.
18.Bouvet L, Stoian A, Jacquot-Laperriére S, Allaouchi-che B, Chassard D, Boselli E. Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study. Can J Anaesth. 2008;55(10):674-84.
19.Rincón JA, Hernández A, Charris H, Montes FR. Intubación orotraqueal sin relajante muscular: propofol o etomidato en combinación con remifentanilo. Rev Col Anest. 2009;37(2): 119-29.
The publisher (Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E.) retains copyright for the published articles.
Creative Commons License
Articles published by Colombian Journal of Anesthesiology are licensed under the Creative Commons 4.0 license: Attribution-NonCommercial-NoDerivs: CC BY-NC-ND.