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Canadian Journal of Anesthesia 52:337-338 (2005)
© Canadian Anesthesiologists' Society, 2005

Correspondence

Evaluating intubating conditions using the GCRP recommendations

François Donati, PhD MD FRCPC

Hôpital Maisonneuve-Rosemont, Montréal, Canada, E-mail: francois.donati{at}umontreal.ca

To the Editor:

I read with great interest the article by Yang et al.1 describing differences in postoperative nausea and vomiting between sevoflurane-remifentanil and propofol-fentanyl-rocuronium induction methods. The authors also evaluated intubating conditions according to a system (TableGo) proposed by experts in neuromuscular pharmacology at a consensus conference held in Denmark in 1994 and published as an article entitled: "Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents".2 Although the article has been quoted widely, its recommendations have not always been followed and important variations have been introduced.


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  		TABLE The GCRP recommendations on intubating conditions2
 
Although Yang et al.1 claim that their "...intubating score is based on the GCRP consensus conference...", they increased the number of categories from five to six, with "manual ventilation" added. The other five factors do not match exactly. More important, Yang et al.1 assign points to each result and add them up, instead of considering only three possible final scores (excellent, good and poor), based on the worst result in any category. Thus, there is potential for considerable discrepancy between both scoring systems. For example, the range from 2 to 6 points may correspond to either good or poor scores.

Even with careful evaluation, assessment of intubating conditions remains qualitative and relatively inaccurate. Three possible results (excellent, good and poor), with the addition of a fourth (impossible), are probably enough. There is no need to introduce a system that allows 13 possible results (0–12, or 1–13 as in Figure 1).1 In addition, the GCRP recommendations are widely accepted, and comparisons can be made more easily between studies. The data provided by Yang et al.1 would be more easily interpretable if they had reported the results as excellent, good or poor.

References

1 Yang H, Choi PT, McChesney J, Buckley N. Induction with sevoflurane-remifentanil is comparable to propofol-fentanyl-rocuronium in PONV after laparoscopic surgery. Can J Anesth 2004; 51: 660–7.[Abstract/Free Full Text]

2 Viby-Mogensen J, Engbaek J, Eriksson LI, et al. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular agents. Acta Anaesthesiol Scand 1996; 40: 59–74.[Medline]


Related articles in CJA:

REPLY
Peter T.-L. Choi, Homer Yang, James McChesney, and Norman Buckley
CJA 2005 52: 338. [Full Text]  




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