Tracheal intubation of healthy pediatric patients without muscle relaxant:A survey of technique utilization and perceptions of safety

We conducted a survey of Society for Pediatric Anesthesia anesthesiologists practicing within the United States to determine the frequency of tracheal intubation of healthy infants and children using an inhaled anesthetic wit hout muscle relaxation (IAWMR). We also examined reasons for the use of thi s technique. Of all responders who listed their most often used technique f or tracheal intubation of healthy infants and children, IAWMR was chosen ov er intubation with a muscle relaxant by 38.1% and 43.6%, respectively. Anes thesiologists who most often used IAWMR for tracheal intubation of healthy infants and children had over twice the odds (odds ratio [OR] 2.30 for infa nts, 95% confidence interval [CI] 1.18-4.50; P = 0.015) of classifying thei r own practice as nonacademic, and one-third the odds (OR 0.34 for infants, 95% CI 0.17-0.68; P = 0.002) of conducting more than half of their cases i n a supervisory role. Anesthesiologists who use IAWMR to tracheally intubat e healthy pediatric patients most commonly selected as their reasons the la ck of need for a muscle relaxant and the desire to avoid both succinylcholi ne and the excessive duration of nondepolarizing muscle relaxants. Implicat ions: Inhaled anesthetic without muscle relaxation is the most often used m ethod of intubation for more than one third of Society for Pediatric Anesth esia anesthesiologists when tracheally intubating healthy, fasted pediatric patients undergoing elective procedures. The frequency of this practice se ems to be highest in nonacademic practices.