Keshav Goyal, Hemanshu Prabhakar, Arvind Chaturvedi, Rakesh Kumar and Hari Hara Dash
Objective: The objective of this study was to compare the incidence of laryngeal morbidity after fibre optic tracheal intubation performed under general anaesthesia with versus without muscle relaxant in patients undergoing elective neurosurgical procedures.
Design: Prospective, Randomised. Patients: 100 patients scheduled for elective neurosurgical procedures of age between 15 and 60 years.
Intervention: Patients were assigned to one of the two Groups [Group MR (with muscle relaxant) or Group Non- MR (without muscle relaxant)]. After confirmation of adequate mask ventilation under General Anesthesia, patients received either intravenous Rocuronium 1mg/kg (Group MR) or Saline (Group Non-MR) prepared in identical syringes and same volume.
Measurements: The number of attempts before successful intubation and their duration, number of failures, total intubation time, and events during the whole procedure were recorded. On the first postoperative day, an experienced blinded ENT surgeon assessed hoarseness and vocal cords by oral/indirect laryngoscopy. Data are presented as mean (SD) or number (%).
Results: Fifty two patients were in Group MR and 48 patients were in Group Non-MR. The two groups were comparable with respect to age, sex and weight of the patients. Hoarseness was observed in 50% of patients in the MR group vis a vis 54.2% patients in the Non-MR group (p=0.95). Vocal cord sequelae were seen in 27% of patients in Group MR and 50% of patients in Group Non-MR (p<0.018).
Conclusion: We conclude that although vocal cord sequelae associated with fibreoptic intubation with the use of muscle relaxant is significantly lower than without muscle relaxant, there is not much of difference observed in overall laryngeal morbidity. Authors recommend using muscle relaxant while doing fibre optic tracheal intubation under general anaesthesia, unless contraindicated so that the intubation is easier, better tolerated and associated with less laryngeal morbidity.