Birkholz Torsten, Irouschek Andrea, Saalfrank-Schardt Christina, Klein Peter, Schmidt Joachim
Department of Anaesthesiology, University of Erlangen-Nuremberg, Nuremberg, Germany.
Auris Nasus Larynx. 2012 Jun;39(3):288-93. doi: 10.1016/j.anl.2011.07.001. Epub 2011 Aug 20.
The avoidance of neuromuscular blocking agents (NMBA) for endotracheal intubation is associated with a higher incidence of laryngeal discomfort and lesions, but could impair effectiveness of intra operative recurrent laryngeal nerve monitoring (IONM).
In a retrospective quality assessment study over a period of 30 months, a collective that had been intubated without NMBA was compared with a group, which had received NMBA. Endolaryngeal EMG was accomplished with a MagStim(®)-EMG-electrode.
Out of the 127 patients with 224 nerves at risk (NAR; NMBA 102 NAR, no NMBA 122 NAR), more than 90% received a total intravenous anaesthesia with propofol, and 88% had remifentanil. Laryngeal side effects and damage scores did not differ significantly.
In this special setting of IONM and thyroid surgery, avoidance of NMBA for endotracheal intubation seems not to increase the incidence of laryngeal side effects and lesions. If endotracheal intubation without NMBA is required, the authors suggest a standardized approach using induction agents as propofol and remifentanil.
气管插管时避免使用神经肌肉阻滞剂（NMBA）与更高的喉部不适和损伤发生率相关，但可能会损害术中喉返神经监测（IONM）的有效性。
在一项为期30个月的回顾性质量评估研究中，将未使用NMBA进行插管的一组患者与接受NMBA的一组患者进行比较。使用MagStim（®）-肌电图电极进行喉内肌电图检查。
在127例有224条神经有风险（NAR；NMBA组102条NAR，未使用NMBA组122条NAR）的患者中，超过90%接受了丙泊酚全静脉麻醉，88%使用了瑞芬太尼。喉部副作用和损伤评分无显著差异。
在这种IONM和甲状腺手术的特殊情况下，气管插管时避免使用NMBA似乎不会增加喉部副作用和损伤的发生率。如果需要在不使用NMBA的情况下进行气管插管，作者建议采用标准化方法，使用丙泊酚和瑞芬太尼等诱导药物。
