Comparison of four facial muscles, orbicularis oculi, corrugator supercilii, masseter or mylohyoid, as best predictor of good conditions for intubation

Lee, Hee J; Kim, Kyo Sang; Jeong, Ji Seon; Shim, Jae Chul; Oh, You Na

doi:10.1097/eja.0b013e3283625039

Cited by 9 publications

(9 citation statements)

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“…The depth of anesthesia is known to influence intubating conditions: therefore, all variables of anesthesia were standardised. The size of the groups was similar to those in other studies dealing with this topic [ 10 , 11 , 15 ], and the rate of excellent intubating conditions (73%) was comparable to the results of other authors observing 70 to 80% [ 16 , 17 ]. However, we were not able to find differences between both measurement sites with regard to intubating conditions.…”

Section: Discussionsupporting

confidence: 87%

“…The authors observed best intubating conditions if the adductor pollicis muscle was chosen to predict onset of the neuromuscular block; however, with the longest delay between start of anesthesia and tracheal intubation. In a second study, they compared orbicularis oculi, corrugator supercilii, masseter and mylohyoid muscles with each other [ 11 ]. Again, best intubating conditions were observed at the measurement sites with the longest delay between induction and complete neuromuscular block (mylohyoid muscle).…”

Section: Discussionmentioning

confidence: 99%

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Comparison of the trapezius and the adductor pollicis muscle as predictor of good intubating conditions: a randomized controlled trial

et al. 2017

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BackgroundAdequate muscle relaxation is important for ensuring optimal conditions for intubation. Although acceleromyography of the adductor pollicis muscle is commonly used to assess conditions for intubation, we hypothesized that acceleromyography of the trapezius is more indicative of optimal intubating conditions. The primary outcome was the difference between both measurement sites with regard to prediction of good or acceptable intubating conditions.MethodsNeuromuscular blockade after injection of rocuronium 0.3 mg/kg IV was measured simultaneously with acceleromyography of the adductor pollicis muscle and the trapezius muscle in sixty female patients, American Society of Anesthesiologists physical status I to III, undergoing general anesthesia for gynecologic surgery. Exclusion criteria were: expected difficult tracheal intubation (e.g. history of difficult intubation, reduced mouth opening (< 2 cm) and/or Mallampati Score 4), increased risk of pulmonary aspiration (e.g. gastroesophageal reflux or delayed gastric emptying) allergies to drugs used during the study, pregnancy, neuromuscular diseases, medication with potential to influence neuromuscular function (e.g. furosemide, magnesium, cephalosporins) and hepatic or renal insufficiency (serum bilirubin >26 μmol/L, serum creatinine >90 μmol/l). Patients were randomized to 2 groups: group A (n = 30): endotracheal intubation after onset of the neuromuscular block at the adductor pollicis muscle. Group B (n = 30): endotracheal intubation after onset at the trapezius muscle. Intubating conditions were compared between both groups by means of a standardised score (the Copenhagen score) with Fisher’s exact test.ResultsOnset of the block after rocuronium injection was observed at the adductor pollicis muscle compared to the trapezius with 2.8 (1.1) versus 2.5 (1.1) min (mean ± SD; P = 0.006). Intubating conditions were poor in 2 patients (7%) of group A, and in 1 patient (3%) of group T. They were acceptable (either excellent or good) in 28 patients (93%) in group A, and in 1 patient (97%) in group T (P = 0.82).ConclusionsPerforming acceleromyography at the trapezius muscle reduced the time between injection of neuromuscular blocking agents and intubation by 18 s (11%). Thus, trapezius muscle acceleromyography is an acceptable alternative to adductor pollicis muscle acceleromyography in predicting acceptable intubating conditions, which allows for earlier indication of adequate intubating conditions.Trial registrationClinicalTrial.gov Identifier: NCT01849198. Registered April 29, 2013.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Comparison of the trapezius and the adductor pollicis muscle as predictor of good intubating conditions: a randomized controlled trial

et al. 2017

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“…Intubation conditions are related more closely to the degree and time of onset of NMB in the laryngeal adductors, diaphragm, and masseter muscles than in the adductor pollicis muscle ( 15 ). Monitoring NMB at different muscles may provide additional information that can be used to effectively prevent hemodynamic responses to intubation despite good or excellent intubation conditions ( 15 - 17 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, with nociceptive stimulation (laryngoscopy), the increase in BIS in patients who received rocuronium (0.6 mg/kg) was significantly lower than in patients who did not (saline) ( 18 ). We performed intubation when the TOF ratio reached zero to prevent the sympathetic response to stimulus before intubation and the large interindividual variation in neuromuscular depression that can occur after administration of NMB agents ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of conventional vs high-dose rocuronium on the QTc interval during anesthesia induction and intubation in patients undergoing coronary artery surgery: a randomized, double-blind, parallel trial

Öztürk

Agdanli

Bayturan

et al. 2015

Braz J Med Biol Res

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Myocardial ischemia, as well as the induction agents used in anesthesia, may cause corrected QT interval (QTc) prolongation. The objective of this randomized, double-blind trial was to determine the effects of high- vs conventional-dose bolus rocuronium on QTc duration and the incidence of dysrhythmias following anesthesia induction and intubation. Fifty patients about to undergo coronary artery surgery were randomly allocated to receive conventional-dose (0.6 mg/kg, group C, n=25) or high-dose (1.2 mg/kg, group H, n=25) rocuronium after induction with etomidate and fentanyl. QTc, heart rate, and mean arterial pressure were recorded before induction (T0), after induction (T1), after rocuronium (just before laryngoscopy; T2), 2 min after intubation (T3), and 5 min after intubation (T4). The occurrence of dysrhythmias was recorded. In both groups, QTc was significantly longer at T3 than at baseline [475 vs 429 ms in group C (P=0.001), and 459 vs 434 ms in group H (P=0.005)]. The incidence of dysrhythmias in group C (28%) and in group H (24%) was similar. The QTc after high-dose rocuronium was not significantly longer than after conventional-dose rocuronium in patients about to undergo coronary artery surgery who were induced with etomidate and fentanyl. In both groups, compared with baseline, QTc was most prolonged at 2 min after intubation, suggesting that QTc prolongation may be due to the nociceptive stimulus of intubation.

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“…En estudios comparando la monitorización de varios grupos musculares se obtuvo el menor tiempo en alcanzar el bloqueo máximo con el OO 75 , aunque las condiciones de intubación no son siempre aceptables 76 . Monitorizando el músculo AP se obtiene condiciones de intubación excelentes, aunque con mayor retraso en alcanzar el bloqueo máximo tras la administración de un bolo de relajante muscular.…”

Section: Fonomiografía (Pmg)unclassified

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

Ruiz

Cayuela

Montes

et al. 2017

Revista Española de Anestesiología y Reanimación

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Comparison of four facial muscles, orbicularis oculi, corrugator supercilii, masseter or mylohyoid, as best predictor of good conditions for intubation

Abstract: IRB File No.: HYUH 2012-07-009.

Cited by 9 publications

References 20 publications

Comparison of the trapezius and the adductor pollicis muscle as predictor of good intubating conditions: a randomized controlled trial

Comparison of the trapezius and the adductor pollicis muscle as predictor of good intubating conditions: a randomized controlled trial

Effects of conventional vs high-dose rocuronium on the QTc interval during anesthesia induction and intubation in patients undergoing coronary artery surgery: a randomized, double-blind, parallel trial

Monitorización intraoperatoria del bloqueo neuromuscular y la presión arterial con un solo dispositivo (TOF-Cuff): estudio comparativo con la mecanomiografía y la presión arterial invasiva

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