నైరూప్య

Is immediate muscle relaxation still forbidden?

Heuer JF and Bleckmann A

Background: The purpose of this study was to confirm that muscle relaxation can be safely induced before attempting face mask ventilation (FMV), like the updated guideline for the management of tracheal intubation in critically ill adults recommends. In the past, the rule was only inducing muscle relaxation after having confirmed that FMV could be successfully performed. Even several studies could show in recent years that this approach is not appropriate anymore; most institutions still refuse the concept of the early relaxation.

Methods: Applying the currently available data we modified our standard anesthesia induction procedure regarding when the neuromuscular blocking agent (NMBD) was injected. All patients in whom no difficulties with FMV were expected were given the NMBD immediately after induction of anesthesia without first assessing if FMV was possible. The data was later collected from our Patient Data Management System (PDMS).

Results: A total of 3,801 patients were included in this study. FMV was not possible in only one patient (0.026%), but the airway was secured with a laryngeal mask airway (LMA). FMV without an oropharyngeal airway (OA) was difficult in 2.4% of the patients and in a further 1.9% when the OA was employed.

Conclusion: Muscle relaxation can be safely induced without first assessing the ease of FMV, because it doesn’t make FMV more difficult, as only 0.03% of the FMV were impossible. So, it is about time that anesthesia departments will adapted their anesthesia induction procedures to the current literature and guidelines.