Paralysis Versus Non‐Paralysis Anesthesia for Operative Laryngoscopy: A Randomized Controlled Trial

alexandrossfakianakis shared this article with you from Inoreader Paralysis Versus Non‐Paralysis Anesthesia for Operative Laryngoscopy: A Randomized Controlled Trial via The Laryngoscope We conducted a prospective, single-blinded randomized controlled trial at an ambulatory surgery center comparing two standard-of-care anesthesia regimens for laryngeal surgeries using a direct laryngoscopy approach: anesthesia with paralysis using rocuronium and anesthesia without paralysis using a continuous remifentanil/propofol infusion. Intraoperative impressions, anesthesia data, and post-operative patient surveys were collected. Anesthesia with paralysis during direct laryngoscopy was associated with more favorable surgical conditions and post-op pain compared to anesthesia with propofol and remifentanil. Objective To compare outcomes between two standard-of-care anesthesia regimens for operative laryngoscopy: general anesthesia with a neuromuscular blocking agent (NMBA) versus remifentanil and propofol (non-NMBA). Methods This was a prospective, single-blinded, randomized controlled trial at a tertiary care center. Patients were randomized to either anesthesia using rocuronium (NMBA) or with remifentanil/propofol infusion alone (non-NMBA). Intraoperative impressions, anesthesia data, and post-operative patient surveys were collected. Results Sixty-one patients who underwent suspension laryngoscopy from 2020 to 2022 were included (25 female, 36 male, ranging 20–81 years). Thirty patients were enrolled in the NMBA arm and 31 patients in the non-NMBA arm. Heart rate and mean arterial pressure were higher in the NMBA (p < 0.01). Patients in the non-NMBA group were more likely to require vasopressors (p = 0.04, RR = 3.08 [0.86–11.05]). Surgeons were more frequently satisfied with conditions in the NMBA group (86.7%) compared to the non-NMBA group (58.1%, p < 0.01). Procedures were more likely to be paused due to movement in the non-NMBA group (45.1%) compared to the NMBA group (16.6%, p < 0.03, RR = 2.26 [1.02–4.99]). Patients in the non-NMBA group were more likely to endorse myalgia the week after surgery (44%) compared to the NMBA group (8.3%, p < 0.01) and reported higher average pain levels on a 0–10 pain scale (3.7) compared to the paralysis group (2.0). Conclusions Anesthesia with rocuronium was associated with better intraoperative conditions and postoperative pain compared to anesthesia with remifentanil/propofol. Remifentanil/propofol were associated with lower blood pressure and suppression of laryngoscopy-associated tachycardia. Level of Evidence Level 2 Laryngoscope, 2023 View on Web

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