La omisión de la relajación neuromuscular en pacientes ambulatorios que requieren intubación orotraqueal incrementa temporalmente la incidencia de síntomas laríngeos postoperatorios: estudio cuasi-experimental (original) (raw)
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Anaesthesia & Critical Care Medicine Journal, 2018
Background: Tracheal intubation is achieved with drugs given for the induction of general anesthesia. This process is facilitated by administering a muscle relaxant. However, administration of muscle relaxants may be associated with side effects. The necessity to avoid the use of muscle relaxants becomes imperative in patients who are allergic to neuromuscular relaxants, or with difficult airway. The rationale for tracheal intubation without muscle relaxants may not be obvious to many health care providers in adults. Avoiding muscle relaxants can prevent the potential complications of their use and a faster return of spontaneous ventilation may be evidenced. Anesthesia inducction with gas may be an alternative to a safe and efficient orotracheal intubation without muscle relaxants and analgesic drugs. The aim of this study was to identify complications and evaluate the efficacy of pure inhalational anesthesia induction to achieve endotracheal intubation without the use of muscle relaxant and analgesic drugs. Methods: Prospective and randomiced study in 91 patients. Anesthesia induction was performed, without analgesics and muscle relaxants. The optimal intubation conditions were considered when the laryngoscopy showed the glottis completely open. Results: Orotracheal intubation was performed in 100%. The mean time lapsed until optimal conditions for intubation were achieved was 6 ± 0.88 minutes. The mean sevoflurane end-tidal volume at which intubation could be performed was 5.5% ± 0.26%.Transitory apnea in 57.1%, and apnea in 1.1%. Nausea and vomiting was 6.6%.
Critical Care Medicine, 2012
Background: emergent intubation is associated with a high rate of complications. Neuromuscular blocking agents are routinely used in the operating room and emergency department to facilitate intubation. However, use of neuromuscular blocking agents during emergent airway management outside of the operating room and emergency department is controversial. We hypothesized that the use of neuromuscular blocking agents is associated with a decreased prevalence of hypoxemia and reduced rate of procedurerelated complications. Methods: Five hundred sixty-six patients undergoing emergent intubations in two tertiary care centers, Massachusetts General Hospital, Boston, MA, and the University of California Los Angeles, ronald reagan Medical Center, Los Angeles, CA, were enrolled in a prospective, observational study. The 112 patients intubated during cardiopulmonary resuscitation were excluded, leaving 454 patients for analysis. All intubations were supervised by attendings trained in Critical Care Medicine. We measured intubating conditions, oxygen saturation during and 5 mins following intubation. We assessed the prevalence of procedure-related complications defined as esophageal intubation, traumatic intubation, aspiration, dental injury, and endobronchial intubation. Results: The use of neuromuscular blocking agents was associated with a lower prevalence of hypoxemia (10.1% vs. 17.4%, p 5 .022) and a lower prevalence of procedure-related complications (3.1% vs. 8.3%, p 5 .012). This association persisted in a multivariate analysis, which controlled for airway grade, sedation, and institution. Use of neuromuscular blocking agents was associated with significantly improved intubating conditions (laryngeal view, p 5 .014; number of intubation attempts, p 5 .049). After controlling for the number of intubation attempts and laryngoscopic view, muscle relaxant use is an independent predictor of complications associated with emergency intubation (p 5 .037), and there is a trend towards improvement of oxygenation (p 5 .07). Conclusion: The use of neuromuscular blocking agents, when used by intensivists with a high level of training and experience, is associated with a decrease in procedure-related complications.
Acta Anaesthesiologica Scandinavica, 1999
Background: Depolarizing and non-depolarizing muscle relaxants possess many untoward side effects. In most patients endotracheal intubation may be performed with a propofol and alfentanil combination. The purpose of this study was to compare the effect on intraocular pressure (IOP) and haemodynamics of endotracheal (ET) intubation or laryngeal mask (LMA) insertion during total intravenous anaesthesia (TIVA) without the use of muscle relaxants. Methods: In a randomised study, 20 patients scheduled for elective orthopaedic surgery were assigned to two groups of 10 patients. Anaesthesia was induced with i.v. alfentanil 40 mg/kg and propofol 2.5 mg/kg. LMA insertion or ET intubation was achieved by the same anaesthesiologist. Airway score, insertion score, patient response and haemodynamics were recorded. IOP measurements were recorded before and after induction, 1 and 2 min after ET intubation or LMA insertion, and 1 and 2 min after extubation. Results: Mean arterial pressure and heart rate after insertion of
Can J Anaesth, 2003
To compare the ease of tracheal intubation without the use of muscle relaxants following an alfentanil-lidocaine-propofol sequence vs a fentanyl-lidocaine-propofol sequence. C Cl li in ni ic ca al l f fe ea at tu ur re es s: : In 80 ASA I and II adult patients undergoing elective laparoscopic surgery, we compared the intubating conditions following alfentanil 20 µg•kg-1 , lidocaine 1.5 mg•kg-1 , propofol 3 mg•kg-1 (Group I; n = 40) vs fentanyl 2 µg•kg-1 , lidocaine 1.5 mg•kg-1 , propofol 3 mg•kg-1 (Group II; n = 40). The intubating conditions were scored by jaw relaxation, vocal cord position and response to intubation, as well as by blood pressure and heart rate changes. The intubating conditions were good or excellent in 95% of patients in Group I vs 62.5% of patients in Group II (P < 0.05). Blood pressure decreased from a preinduction value of 86 ± 13 mmHg to 72 ± 28 mmHg and 74 ± 19 mmHg in Group I, and from 85 ± 12 mmHg to 78 ± 15 mmHg and 78 ± 12 mmHg in Group II, one and five minutes following intubation (P < 0.05). This drop in blood pressure was not different between the two groups. C Co on nc cl lu us si io on n: : An alfentanil-lidocaine-propofol sequence offers significantly better intubating conditions than a fentanyl-lidocainepropofol sequence in healthy adult patients.
Earlier Endotracheal Intubation by Entropy Guidance Versus Neuromuscular Monitoring
Archives of Neuroscience
Background: The entropy electrode is centrally placed on the forehead over the muscles of frontalis, orbicularis oculi, and corrugator supercilii. It determines response entropy (RE), which is the electromyogram component, and state entropy (SE), which is the electroencephalogram component. We hypothesized that due to the central location of entropy, the decreasing value of RE-SE ≤ 2 with SE ≤ 45 could denote an adequate combination of hypnosis, muscle paralysis, and analgesia required for endotracheal intubation. This could result in earlier intubation compared to when guided by train-of-four (TOF) = 0. Objectives: The primary objective of the study was to evaluate if entropy values of RE-SE ≤ 2 with SE ≤ 45 can be used as a measure of adequate condition for endotracheal intubation. We also sought to determine the TOF at this point. Methods: Endotracheal intubation was performed in group E (Entropy; n = 30) at RE-SE ≤ 2 with SE ≤ 45 and in group T (TOF; n = 30) at TOF = 0. A propofol bolus (20 mg) was administered if the patient had a hypertensive response or moved in response to endotracheal intubation. The TOF was noted at the time of intubation in group E. We also measured the time to intubation, jaw and vocal cord relaxation, patient movement or coughing, SE, TOF, and vital parameters. Statistical analysis was performed with two-tailed students' t test, paired t test, chi-square test, and ANOVA. The difference between groups was considered significant if the p value was < 0.05. Results: The time to intubation was significantly shorter in group E than in group T (92.5 ± 63.5 seconds vs. 209.2 ± 59.6 seconds; P < 0.001) with a mean TOF of 87.3% ± 8.4% in group E. Intubating conditions in terms of jaw relaxation, patient movement, and coughing were not significantly different between the two groups. Vocal cord relaxation was significantly inadequate in six patients in group E (P < 0.01); however, there was no difficulty in introducing the endotracheal tube with no postoperative adverse effects such as sore throat. Conclusions: Adequate conditions for endotracheal intubation were achieved 90 seconds after the administration of fentanyl, propofol, and vecuronium for anesthesia induction when it is guided by RE-SE ≤ 2 with SE ≤ 45, which is earlier than when guided by TOF = 0.
The Kaohsiung Journal of Medical Sciences, 2010
Muscle relaxants are frequently used to facilitate endotracheal intubation during the induction of anesthesia . However, the administration of short-acting depolarizing muscle relaxants is associated with postoperative myalgias, malignant hyperthermia, hyperkalemia and increased intracranial or intraocular The aim of this study was to compare the effects of fentanyl or dexmedetomidine when used in combination with propofol and lidocaine for tracheal intubation without using muscle relaxants. Sixty patients with American Society of Anesthesiologists stage I risk were randomized to receive 1 μg/kg dexmedetomidine (Group D, n = 30) or 2 μg/kg fentanyl (Group F, n = 30), both in combination with 1.5 mg/kg lidocaine and 3 mg/kg propofol. The requirement for intubation was determined based on mask ventilation capability, jaw motility, position of the vocal cords and the patient's response to intubation and inflation of the endotracheal tube cuff. Systolic arterial pressure, mean arterial pressure, heart rate and peripheral oxygen saturation values were also recorded. Rate pressure products were calculated. Jaw relaxation, position of the vocal cords and patient's response to intubation and inflation of the endotracheal tube cuff were significantly better in Group D than in Group F (p < 0.05). The intubation conditions were significantly more satisfactory in Group D than in Group F (p = 0.01). Heart rate was significantly lower in Group D than in Group F after the administration of the study drugs and intubation (p < 0.05). Mean arterial pressure was significantly lower in Group F than in Group D after propofol injection and at 3 and 5 minutes after intubation (p < 0.05). After intubation, the rate pressure product values were significantly lower in Group D than in Group F (p < 0.05). We conclude that endotracheal intubation was better with the dexmedetomidine-lidocaine-propofol combination than with the fentanyl-lidocaine-propofol combination. However, side effects such as bradycardia should be considered when using dexmedetomidine.