Optimising conditions for tracheal intubation: should neuromuscular blocking agents always be used?

Hunter, Jennifer M.

doi:10.1016/j.bja.2018.01.043

Cited by 7 publications

(4 citation statements)

References 29 publications

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“…Some trials reported failure rates and adverse events of up to 20% when NMBAs are omitted . This is inadmissible even in patients in whom intubating is difficult . However, in many relaxant‐free study arms, tracheal intubation has been carried out at light‐to‐moderate planes of anesthesia in which airway reflexes can be enhanced.…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

Vanlinthout

Geniets

Driessen

et al. 2020

Pediatric Anesthesia

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Background:The benefit of using neuromuscular-blocking agents to facilitate tracheal intubation in pediatric patients remains unclear due to variations in design, treatments, and results among trials. By combining the available evidence, we aimed to establish whether scientific findings are consistent and can be generalized across various populations, settings, and treatments. Methods:A systematic search for randomized controlled trials, related to the use of neuromuscular-blocking agents for tracheal intubation in American Society of Anesthesiologists class I-II participants (0-12 years), was performed. We considered all randomized controlled trials that studied whether intubation conditions and hemodynamics obtained by using neuromuscular-blocking agents were equivalent to those that were achieved without neuromuscular-blocking agents. We combined the outcomes in Review Manager 5.3 (RevMan, The Cochrane Collaboration) by pairwise random-effects meta-analysis using a risk ratio (RR) for intubation conditions and mean difference for hemodynamic values (mean [95% Confidence Intervals]).Heterogeneity among trials was explored using sensitivity analyses. Results:We identified 22 eligible randomized controlled trials with 1651 participants.Overall, the use of a neuromuscular-blocking agent was associated with a clinically important increase in the likelihood of both excellent (RR = 1.41 [1.19-1.68], I 2 = 76%) and acceptable (RR = 1.13 [1.07-1.19], I 2 = 68%) intubating conditions. There is strong evidence that both unacceptable intubation conditions (RR = 0.35 [0.22-0.46], I 2 = 23%) and failed first intubation attempts (RR = 0.25 [0.14-0.42], I 2 = 0%) were less likely to occur when a neuromuscular-blocking agent was used compared with when it was not. Higher systolic or mean arterial pressures (mean difference = 13.3 [9.1-17.5] mm Hg, I 2 = 69%) and heart rates (mean difference = 15.9 [11.0-20.8] beats/ min, I 2 = 75%) as well as a lower incidence of arrhythmias were observed when tracheal intubation was facilitated by neuromuscular-blocking agents. Conclusion:The use of a neuromuscular-blocking agent during light-to-moderate depth of anesthesia can improve the quality as well as the success rate of tracheal intubation and is associated with better hemodynamic stability during induction of anesthesia. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Vanlinthout LE, Geniets B, Driessen JJ, et al. Neuromuscular-blocking agents for tracheal intubation in pediatric patients: A systematic review and meta-analysis.

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Section: Discussionmentioning

confidence: 99%

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

Vanlinthout

Geniets

Driessen

et al. 2020

Pediatric Anesthesia

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“…EditordI thank Dr Rodney and colleagues 1 for their interest in my editorial 2 and for their comments. I accept that there is a need for anaesthetists to gain experience in tracheal intubation without the use of neuromuscular blocking agents (NMBAs) for the uncommon instances when their use is contraindicated.…”

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confidence: 99%

Should neuromuscular blocking agents always be used for tracheal intubation? Reply to Br J Anaesth 2018; 122: e8–9

Hunter¹

2019

British Journal of Anaesthesia

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“…EditordI thank Boselli 1 for his comments on my editorial, 2 written in response to Lundstrom and colleagues' metaanalysis 3 reporting the benefits of using neuromuscular blocking agents (NMBAs) to aid tracheal intubation. My major concern with Boselli's argument is that the research he reports is limited to ASA physical status 1e2 patients receiving high doses of remifentanil (4 mg kg À1 ).…”

mentioning

confidence: 99%

Tracheal intubation without the use of neuromuscular blocking drugs. Reply to Br J Anaesth 2018; 121: e9–10

Hunter¹

2019

British Journal of Anaesthesia

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3. Bouvet L, Stoian A, Rimmel e T, Allaouchiche B, Chassard D, Boselli E. Optimal remifentanil dosage for providing excellent intubating conditions when coadministered with a single standard dose of propofol. Anaesthesia 2009; 64: 719e26 4. Bouvet L, Stoian A, Jacquot-Laperri ere S, Allaouchiche B, Chassard D, Boselli E. Laryngeal injuries and intubating conditions with or without muscular relaxation: an equivalence study. Can J Anaesth 2008; 55: 674e84 5. Bouvet L, Chassard D, Boselli E. Tracheal intubation without muscle relaxants: large doses of opioids, small endotracheal tubes. Eur J Anaesthesiol 2006; 23: 712e3 6. Stevens JB, Wheatley L. Tracheal intubation in ambulatory surgery patients: using remifentanil and propofol without muscle relaxants.

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Optimising conditions for tracheal intubation: should neuromuscular blocking agents always be used?

Cited by 7 publications

References 29 publications

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

Neuromuscular‐blocking agents for tracheal intubation in pediatric patients (0‐12 years): A systematic review and meta‐analysis

Should neuromuscular blocking agents always be used for tracheal intubation? Reply to Br J Anaesth 2018; 122: e8–9

Tracheal intubation without the use of neuromuscular blocking drugs. Reply to Br J Anaesth 2018; 121: e9–10

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