Neuromuscular Blocking Agents and Tracheal Intubation: Systematic Review and Meta‐Analysis of Effects on Laryngeal Complications and Intubating Conditions

Abstract

ABSTRACT Background and Aims The use of neuromuscular blocking agents (NMBAs) in tracheal intubation is widely accepted in anesthetic induction, but adverse effects are possible. We performed a systematic review and meta‐analysis to compare influence of use and nonuse of NMBAs on incidence of laryngeal complications and intubating conditions in surgical patients. Methods We searched PubMed, Web of Science, Embase, and Cochrane Library for randomized controlled trials comparing use of NMBAs with either placebo or no treatment for oral tracheal intubation in adult patients under general anesthesia. Studies were evaluated using a risk‐of‐bias assessment. We conducted random‐effects or fixed‐effects meta‐analyses on extracted data and calculated risk ratio (RR), risk difference (RD), and 95% confidence interval (CI). Results Nine trials with 1176 participants were included. Incidence of postoperative sore throat or hoarseness did not differ between groups receiving and not receiving NMBAs at 24 h (RR: 1.18; 95% CI: 0.96–1.46; I2 = 45%), 48 h (RR: 0.84; 95% CI: 0.46–1.52; I2 = 42%), or 72 h (RD: −0.00; 95% CI: −0.08 to 0.07; I2 = 59%). Compared with use of NMBAs, induction without NMBAs reduced the occurrence of acceptable intubating conditions (RR: 0.80; 95% CI: 0.67–0.94; I2 = 92%) and with increased risk for poor intubating conditions (RR: 4.77; 95% CI: 3.20–7.10; I2 = 0%). The pharmacological interventions for hemodynamic changes after intubation did not differ significantly between the NMBAs and non‐NMBAs groups (RR: 1.02; 95% CI: 0.53–1.95; I2 = 78%). Conclusion Endotracheal intubation without NMBAs does not increase the incidence of postoperative hoarseness or sore throat in adult surgical patients, which may be considered as a safe and effective technique of anesthesia induction. Although NMBAs use was associated with acceptable intubating conditions and reduced risk for poor intubation conditions. Trial Registration PROSPERO CRD42021284813

Keywords

• anesthesia
• hoarseness
• intubation
• muscle relaxant
• sore throat