EVALUATION OF INTUBATION CONDITIONS IN PA TIENTS PARALYZED WITH ROCURONIUM

Purpose: To evaluate the tracheal intubating conditions when intubatio n time is determined by the onset time of the neuromuscular block eith er of the adductor pollicis (AP) or of the orbicularis oculi muscle (O O). Methods: In this prospective, double blind, randomised study, 40 a dults ASA I-II undergoing general anaesthesia with tracheal intubation were allocated to two groups (n = 20) according to the reference musc le (AP or OO) used to determine the appropriate intubation time, Induc tion of anaesthesia was achieved with 5-7 mg . kg(-1) thiopentone, 1.5 -2.5 mu g . kg(-1) fentanyl and 0.9 mg . kg(-1) rocuronium (3 x ED95) for muscular relaxation. Supramaximal train of four stimulation of the ulnar and facial nerve every 10 sec was used to monitor the neuromusc ular block. After visual loss of AP or OO contraction, tracheal intuba tion and quality of intubation assessment were performed by two indepe ndent anaesthetists, Data are expressed as mean and standard error of the mean (X +/- SEM). Results: Curarisation time of the OO was shorter (110 +/- 4,9 sec) than that of the AP (144 +/- 5,5 sec; P< 0.0001). I ntubation conditions were excellent in 95% and good in 5% of the patie nts in the AP group whereas in the OO group only 65% of the patients h ad excellent and 20% good intubation conditions (P < 0.05). Coughing w as observed in 15% of patients in the OO group during tracheal intubat ion. Conclusion: Monitoring neuro-muscular activity of the AP using TO F to determine the appropriate tracheal intubation time and conditions in patients paralysed with rocurorium is more clinically relevant tha n monitoring the OO muscle.