[Endotracheal intubation without the use of muscle relaxants in patients with myasthenia gravis].

Abstract

INTRODUCTION:

Although muscle relaxants have been widely used to facilitate endotracheal intubation, the administration of these drugs in myasthenic patients may be associated with adverse events.

MATERIAL AND METHODS:

After obtaining Institutional Reviewing Board approval and informed, patient consent, 30 patients with myasthenia gravis were enrolled in a prospective, double-blind, randomized clinical trial. We compared intubating conditions (ease of laryngoscopy, vocal cords, cough, jaw relaxation, limb movement) following fentanyl 2 mg/kg and propofol 2 mg/kg (group PRO, n = 15) vs fentanyl 2 mg/kg and sevoflurane 5% in a 1:2 mixture of oxygen and nitrous oxide (group SEVO, n = 15). The statistical analysis was performed using Student's t test and Chi-quadrate test, p < 0.05 being regarded as significant.

RESULTS:

The overall intubating conditions were excellent in 67% of patients in the group PRO vs 80% of patients in the group SEVO (p > 0.05). One patient in each group had clinically unacceptable conditions for intubation. The mean intubation score was 5.7 +/- 1.0 in the group PRO vs 5.9 +/- 0.9 in the group SEVO (p > 0.05). Three patients receiving propofol and one patient receiving sevoflurane had mild hoarseness after the surgery (p > 0.05).

CONCLUSION:

Both propofol and sevoflurane, supplemented with fentanyl, provide good intubating conditions without the use of muscle relaxants in patients with myasthenia gravis.

• Authors: Gordana Vlajković, Radomir Sindelić, Dejan Marković, Milica Terzić, Vesna Bumbasirević
• Journal: Medicinski pregled (Med Pregl) 2009 Sep-Oct Vol. 62 Issue 9-10 Pg. 412-6 ISSN: 0025-8105 [Print] Serbia
• PMID: 20391735 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Anesthetics, Inhalation
• Anesthetics, Intravenous
• Methyl Ethers
• Neuromuscular Agents
• Sevoflurane
• Fentanyl
• Propofol

Topics

• Adult
• Anesthetics, Inhalation
• Anesthetics, Intravenous
• Double-Blind Method
• Female
• Fentanyl
• Humans
• Intubation, Intratracheal (methods)
• Male
• Methyl Ethers
• Myasthenia Gravis (surgery)
• Neuromuscular Agents
• Propofol
• Sevoflurane
• Thymectomy