Paralysis Versus Non‐Paralysis Anesthesia for Operative Laryngoscopy: A Randomized Controlled Trial

Abstract

ObjectiveTo compare outcomes between two standard‐of‐care anesthesia regimens for operative laryngoscopy: general anesthesia with a neuromuscular blocking agent (NMBA) versus remifentanil and propofol (non‐NMBA).MethodsThis was a prospective, single‐blinded, randomized controlled trial at a tertiary care center. Patients were randomized to either anesthesia using rocuronium (NMBA) or with remifentanil/propofol infusion alone (non‐NMBA). Intraoperative impressions, anesthesia data, and post‐operative patient surveys were collected.ResultsSixty‐one patients who underwent suspension laryngoscopy from 2020 to 2022 were included (25 female, 36 male, ranging 20–81 years). Thirty patients were enrolled in the NMBA arm and 31 patients in the non‐NMBA arm. Heart rate and mean arterial pressure were higher in the NMBA (p < 0.01). Patients in the non‐NMBA group were more likely to require vasopressors (p = 0.04, RR = 3.08 [0.86–11.05]). Surgeons were more frequently satisfied with conditions in the NMBA group (86.7%) compared to the non‐NMBA group (58.1%, p < 0.01). Procedures were more likely to be paused due to movement in the non‐NMBA group (45.1%) compared to the NMBA group (16.6%, p < 0.03, RR = 2.26 [1.02–4.99]). Patients in the non‐NMBA group were more likely to endorse myalgia the week after surgery (44%) compared to the NMBA group (8.3%, p < 0.01) and reported higher average pain levels on a 0–10 pain scale (3.7) compared to the paralysis group (2.0).ConclusionsAnesthesia with rocuronium was associated with better intraoperative conditions and postoperative pain compared to anesthesia with remifentanil/propofol. Remifentanil/propofol were associated with lower blood pressure and suppression of laryngoscopy‐associated tachycardia.Level of Evidence2 Laryngoscope, 133:2654–2664, 2023