In 83 patients researchers compared intubation with propofol 1.5 mg/kg, remifentanil 0.30 μg/kg/min & sevoflurane 1.0 MAC to intubation with the same propofol & remifentanil dose, along with rocuronium 0.45 mg/kg.

Acceptable intubating conditions were 18% more frequent in the muscle relaxant group than in those receiving propofol/remi/sevo.

Incidence of laryngeal injury, hoarseness and sore throat was similar between the two groups - which is different to the result from an earlier, larger study of intubation without relaxant: Comparison of two induction regimens using or not using muscle relaxant: impact on postoperative upper airway discomfort.

summary

• Thomas Mencke, Refa Maria Jacobs, Susann Machmueller, Martin Sauer, Christine Heidecke, Anja Kallert, Hans Wilhelm Pau, Gabriele Noeldge-Schomburg, and Attila Ovari.
• Department of Anaesthesia and Intensive Care Medicine, University of Rostock, Schillingallee 35, Rostock 18057, Germany.
• BMC Anesthesiol. 2014 Jan 1; 14: 39.

BackgroundTracheal intubation without muscle relaxants is usually performed with remifentanil and propofol or sevoflurane. Remifentanil 1.0 to 4.0 μg·kg(-1) and propofol 2.0-3.0 mg·kg(-1) or sevoflurane up to 8.0 Vol% provide acceptable, i.e. excellent or good intubating conditions. We hypothesized that sevoflurane 1.0 MAC would provide acceptable intubating conditions when combined with propofol and remifentanil.MethodsEighty-three patients to be intubated were randomised to two groups. The SEVO group received propofol 1.5 mg kg(-1), remifentanil 0.30 μg kg min(-1) and sevoflurane 1.0 MAC; the MR group received the same doses of propofol and remifentanil plus rocuronium 0.45 mg kg(-1). We evaluated intubation and extubation conditions, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS). The vocal cords were examined for injury by videolaryngoscopy before and 24 hours after surgery.ResultsACCEPTABLE INTUBATING CONDITIONS WERE SEEN MORE FREQUENTLY WITH ROCURONIUM THAN WITH SEVOFLURANE: 97% versus 82%; p = 0.03; the subscore for vocal cords was comparable: 100% versus 98%. MAP before intubation decreased significantly compared with the MAP at baseline to the same extent in both groups; ephedrine IV was given in 15 (SEVO) versus 16 (MR) patients; p = 0.93. BIS at tracheal intubation was 27 (13-65) in the SEVO group, 29 (14-62) in the MR group; p = 0.07. Vocal cord injuries (oedema, haematoma) were similar: 4 patients in each group.ConclusionsOverall intubating conditions were better when rocuronium was used; the subscore for vocal cords was comparable. The incidence of side effects was the same in the two groups.Trial RegistrationClinicalTrials.Gov: NCT 01591031.

This article appears in the collection: Neuromuscular myths: the lies we tell ourselves.

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