Tracheal Intubation without the Use of Neuromuscular Blocking Agents in Adult Patients: A Prospective Study

Abstract

: Introduction: Neuromuscular blocking agents (NMBAs) make tracheal intubation easier but can cause adverse effects. Propofol suppresses airway reflexes, and an opioid adds to this effect, so the combination may allow intubation without NMBAs. We evaluated intubating conditions and the haemodynamic response with a propofol – fentanyl technique in adults. Methods: In this prospective study at a tertiary teaching hospital, 100 adults (18 – 65 years, ASA physical status I – III, Mallampati I – II) having elective or emergency surgery under general anaesthesia induced with propofol 3 mg/kg, without NMBA. A single anaesthesiologist graded intubating conditions using Steyn's modification of the Helbo-Hansen score. Secondary outcomes were modified Cormack – Lehane grade, apnoea, laryngoscopy duration, and vitals. Results: Intubating conditions were clinically acceptable in 91 patients (91%) and not acceptable in 9 (9%). Apnea was achieved in all patients. No bradycardia, hypoxia, laryngospasm or bronchospasm occurred. Conclusion: In selected adults with Mallampati I – II airways, propofol 3 mg/kg after fentanyl 2 µg/kg gave clinically acceptable intubating conditions in 91% of patients without NMBAs. Haemodynamic changes were modest and no airway or cardiovascular complications were recorded. The technique may be useful when NMBAs are contraindicated or best avoided.