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Muscle relaxation for tracheal intubation during paediatric anaesthesia: A meta-analysis and trial sequential

Florence Julien-Marsollier1, Daphné Michelet, Myriam Bellon

  • 1From the Department of Anaesthesia and Intensive Care, Robert Debre University Hospital (FJ-M, DM, MB, A-LH, SD); Department of Anaesthesia and Intensive Care, Fondation Ophtalmologique Adolphe de Rothschild (J-MD); Paris Diderot University (FJ-M, DM, MB, A-LH, SD); and DHU PROTECT, INSERM U1141, Robert Debre University Hospital, Paris, France (SD).

European Journal of Anaesthesiology
|February 22, 2017
PubMed

Insights

Muscle relaxants (MR) may improve tracheal intubation conditions in children, though excellent conditions were not significantly different. Further research is needed to confirm findings and assess complications.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Pharmacology

Background:

  • Tracheal intubation in pediatric anesthesia often involves muscle relaxation, a practice debated among clinicians.
  • The optimal approach for achieving adequate intubation conditions in children requires further investigation.

Purpose of the Study:

  • To conduct a meta-analysis comparing the efficacy of muscle relaxants (MR) versus opioids for tracheal intubation in pediatric patients.
  • To evaluate the impact of MR on achieving excellent and acceptable intubation conditions.

Main Methods:

  • A meta-analysis of randomized controlled trials was performed.
  • Exhaustive literature searches identified relevant clinical trials with low risk of bias.
  • Intubation conditions were assessed as primary (excellent) and secondary (acceptable) outcomes.

Main Results:

  • No significant difference in excellent intubation conditions was observed between MR and opioid groups (RR 1.17 [0.96, 1.43]).
  • Trial sequential analysis indicated insufficient power for excellent intubation conditions, suggesting a need for 81 additional patients.
  • Acceptable intubation conditions were more frequent with MR administration (RR 1.25 [1.06, 1.47]), confirmed by trial sequential analysis.
  • Evidence quality was low for excellent and moderate for acceptable intubation conditions.

Conclusions:

  • Muscle relaxants may enhance the quality of tracheal intubation conditions in children.
  • Further studies involving at least 81 children are necessary to confirm these findings.
  • Additional research should investigate the effect of muscle relaxants on intubation-related complications.
Abstract

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