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Tracheal intubation of outpatients with and without muscle relaxants

Linda Collins, MB BCH BAO FFARCSI^*, James Prentice, MD FRCPC^* and Himat Vaghadia, MB BS FRCPC MHSC^*,

^* From the Departments of Anaesthesiaand Health Care and
Epidemiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.

Address correspondence to:Dr. Himat Vaghadia, Department of Anesthesia (LSP2449), Vancouver Hospital and Health Science Centre, 910 West 10th Avenue, Vancouver, B.C. V5Z 4E3 Canada. Phone: 604-875-4304; Fax: 604-875-5209; E-mail: hvaghadi{at}vanhosp.bc.ca

Purpose: To compare intubating conditions and postoperative myalgias in outpatients after intubation with propofol/alfentanil compared with propofol/alfentanil/succinylcholine with and without precurarisation with d-tubocurarine.

Methods: 144 ASA I - II ambulatory patients for dental extraction under anesthesia were studied. Subjects received either 3mg d-tubocurarine (Group II) or saline (Groups I, III) iv prior to induction of anesthesia with 20 µg•kg^–1 alfentanil and 2.5 mg•kg^–1 propofol followed by 1.5 mg•kg^–1 succinylcholine (II and III) or saline 0.9% (I) for muscle relaxation. The ease of airway management and the postoperative incidence, severity and distribution of muscle pains were examined.

Results: Intubation was successful in all patients and there were no differences in jaw mobility, ease of bag-mask ventilation, visualization of the vocal cords or cord position. Limb movement was more common during intubation in Group I (37.5%) than in Group III (8.3%) or Group II (2%), P < 0.05. At home, VAS scores for myalgia were higher in Group III than in Group I and II. Neck myalgia was more common in Group III (72%) than in Groups II (44%) and I (41%), P < 0.05. Myalgias were also more common in Group III patients (P < 0.05).

Conclusion: Acceptable intubating conditions were achieved with propofol and alfentanil alone. Succinylcholine reduced limb movement during intubation but was associated with postoperative myalgias for up to five days. Precurarisation with tubocurarine reduced the severity of succinylcholine myalgia.

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