Comparison of feasibility of endotracheal intubation with and without succinylcholine in the elderly patients

Orotracheal intubation is a common method for airway management in critical situations and for performing different surgeries in operating rooms under general anesthesia. Firstly, an ultra short- acting anesthetic is administered by intravenous (i.v), mask ventilation instituted and then the most common depolarizing muscle relaxant, succinylcholine, injected. Since succinylcholine and other muscle relaxants have some adverse effects, the current study was performed to present an alternative method for endotracheal intubation without muscle relaxants in some certain situations. The present study was a double-blinded clinical trial, which it is performed on 150 elderly patients in Nikocari Hospital, Tabriz. The patients were divided into two groups, study and control. The patients were elective and anesthesia technique was general anesthesia with endotracheal intubation. Patient selection was based on the physical status classification by American Society of Anesthesiologists (ASA). Therefore, the patients who categorized as class I and II of the ASA classification were selected. All the patients’ airway classification was class I with respect to Mallampati test. lidocaine 1-1.5mg/kg, midazolam 1mg, alfentanyl 30 μg/kg, and propofol 2mg/kg was administered for patients in the study group. Patients in the control group were received the following drugs: lidocaine 1-1.5mg/kg, midazolam 1mg, propofol 2mg/kg and succinylcholine 1-1.5 mg/kg. In the study, all the patients were intubated by an anesthesiologist who was not aware of the medications administered and airway classification. Data collection including the time of consciousness loss, jaw relaxation, quality of ventilation, vocal cards position, patients’ response to laryngoscopy, duration of laryngoscopy, was performed using a questionnaire. Statistical analysis was performed by SPSS software. 51.7% of patients were male and 48.3% were female. Average age of the patients was 61.19 ±12.06 year and their weight mean was 591.06Kg. Only 45% of the patients had a previous history of anesthesia and surgery, but none of them had an experience of difficult intubation. According to ASA classfication, 26.7% of the patients were in class І and 73.3% in class II. All patients had the capability of head extension and mouth opening more than 40mm. In the study group, loss of consciousness occurred in less than one minute and more than two minutes was respectively observed in 35% and 1.7% of the patients. No significant difference was detected between the study and the control group with respect to loss of consciousness. Jaw relaxation was very good in 86.7% of patients and ventilation was easy in 94.5% of patients in the study group. In the control group, jaw relaxation was excellent in 98.2% of patients and ventilation was easy about all patients. Vocal cords had an open and complete view in 91.2% of cases in the study group, while it was 94% in control group (p<0.05). In the study group, an easy laryngoscopy was reported in 85% of cases and the duration of laryngoscopy was 11±7.16 seconds, whilst, the duration of laryngoscopy was 10 ±6.08 seconds and easy laryngoscopy was observed in 90.17% of cases in the control group (p<0.05). Hemodynamic changes were sensible in both groups but SPO2 changes were not obvious. Only 17.9% of patients in the study group responded to intubation in form of feeble cough. No response was observed in the control group. Respectively, 96.8% and 98% of the patients in the study and control group did not experience any significant problem about respiratory system in postoperative period. Considering adverse effects of muscle relaxants used for airway management and necessity of performing endotracheal intubation without muscle relaxants by skilled and expert people, as well as given the study results, using this technique is recommend in patients with some certain criteria.