Canadian Journal of Anaesthesia

, Volume 55, Issue 10, pp 674–684

Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study

  • Lionel Bouvet
  • Alina Stoian
  • Sophie Jacquot-Laperrière
  • Bernard Allaouchiche
  • Dominique Chassard
  • Emmanuel Boselli
Reports Of Original Investigations

Abstract

Purpose: The need for muscular relaxation to improve intubat-ing 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 remifen-tanil 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 µg·kg−1iv and propofol 2.5 mg·kg−1iv, with either cisatracu-rium 0.15 mg·kg−1iv (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 andP=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 intu-bating 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.

Lésions laryngées et conditions d’intubation avec ou sans relaxation musculaire : une étude d’équivalence

Résumé

Objectif: Le besoin de relaxation musculaire dans le but d’améliorer les conditions d’intubation et de réduire l’incidence de morbidité laryngée demeure controversé. L’objectif de cette étude était de déterminer l’incidence de lésions laryngées symptomatiques et des conditions d’intubation acceptables (incluant les conditions bonnes et excellentes), avec ou sans cisatracurium pendant l’induction de l’anesthésie, et combiné à des doses modérées de rémifentanil et de propofol.

Méthode: Dans cette étude d’équivalence prospective, randomisée et à double insu, les conditions d’intubation ont été comparées chez 130 patientes ASA I ou II. Toutes les patientes ont reçu 2 µg·kg−1 de rémifentanil iv et 2.5 mg·kg−1 de propofol iv, avec soit 0,15 mg·kg−1 de cisatracurium iv (groupe Cisatracurium), soit une solution saline (groupe Placebo). Les conditions d’intubation trachéale ont été évaluées à l’aide de l’échelle de Copenhague. Un dépistage systématique de l’enrouement et des maux de gorge postopératoires a été réalisé 24 et 48 h après l’anesthésie, suivi d’un examen nasofibros-copique lorsque les symptômes laryngés persistaient à 48 h.

Résultats: L’incidence d’enrouement et de maux de gorge postopératoires à 24 h était de 26,5 % et 21,5 % dans les groupes Cisatracurium et Placebo, respectivement. Quarante-huit heures après l’anesthésie, l’incidence était de 7,8 % et 6,1 %, respectivement (P=0,32 et P=0,50 entre les groupes, respectivement). Dans la population évaluable cliniquement, l’incidence de lésions laryngées symptomatiques, évaluée à 48 h par nasofibrosco-pie, était équivalente dans les deux groupes, soit 1,6 % et 1,5 % dans le groupe Placebo et le groupe Cisatracurium, respectivement (P<0,001 pour le test d’équivalence), tout comme l’occurrence avec des conditions d’intubation acceptable (95,4 % vs 100 %, P<0,05 pour le test d’équivalence). Toutefois, l’occurrence dans les situations où les conditions d’intubation étaient excellentes était plus fréquente dans le groupe Cisatracurium que dans le groupe Placebo (P=0,0003).

Conclusion: À la suite d’une induction de l’anesthésie à l’aide de propofol et de rémifentanil en dose modérée, le cisatracurium n’a pas procuré un taux plus élevé de conditions bonnes à excellentes pour l’intubation trachéale ; en outre, la relaxation musculaire procurée par le cisatracurium n’a pas non plus réduit le taux de lésions laryngées symptomatiques après l’intubation trachéale.

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Copyright information

© Canadian Anesthesiologists’ Society 2008

Authors and Affiliations

  • Lionel Bouvet
    • 2
  • Alina Stoian
    • 2
  • Sophie Jacquot-Laperrière
    • 1
  • Bernard Allaouchiche
    • 2
  • Dominique Chassard
    • 2
  • Emmanuel Boselli
    • 2
  1. 1.Ear, Nose, and Throat SurgeryClaude Bernard Lyon 1 University of LyonLyonFrance
  2. 2.Department of Anesthesia and Intensive CareClaude Bernard Lyon 1 University of LyonLyonFrance

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