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LETTER TO THE EDITOR

Does the Timing of Tracheal Intubation Based on Neuromuscular Monitoring Decrease Laryngeal Injury? Similar Method, Similar Conditions, Conflicting Results

Département d’Anesthésie et de Réanimation, Centre Hospitalier et Universitaire Nord, Marseille, France, geraldine.slehofer{at}m4x.org or marc.leone{at}ap-hm.fr

To the Editor:

Dr. Mencke et al. (1) demonstrated, in a study published in 2003, that the use of a neuromuscular blocking drug (NMBD), compared with placebo, not only improved the conditions for tracheal intubation, but also resulted in fewer vocal cord injuries (VCI) and less postoperative hoarseness (PH). In their article on laryngeal injury caused by intubation (2), the reported incidence of VCI was 8% with NMBD compared to 42% with placebo (16% vs 44% for PH). Surprisingly, in their more recent article, the same group reported an incidence of VCI and PH of 27% and 29%, respectively, with NMBD for intubation, with no significant difference induced by the timing of intubation after NMBD injection. We do not understand how such a difference in the incidence of VCI (8% vs 27%) can be explained, with the same NMBD (i.e., 0.5 mg/kg atracurium), in the same surgical conditions. What accounts for this difference? Do the authors think that changes in tube size or type or difference between induction sequences could account for this threefold increase in VCI incidence? Or, could it be related to the conditions of surgery (elective surgery of the ear in both studies) or the conditions of extubation? In short, do the authors suspect which variables, different between the two studies, account for this difference in VCI incidence?

We thank the authors for providing us such attractive data, and we would be grateful if they could explain their understanding of this difference.

REFERENCES

1. Mencke T, Echternach M, Kleinschmidt S, et al. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology 2003;98:1049–56.[Web of Science][Medline]
2. Mencke T, Echternach M, Plinkert PK, et al. Does the timing of tracheal intubation based on neuromuscular monitoring decrease laryngeal injury? A randomized, prospective, controlled trial. Anesth Analg 2006;102:306–12.[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Slehofer, G. Articles by Leone, M. Search for Related Content PubMed PubMed Citation Articles by Slehofer, G. Articles by Leone, M.