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Evitación versus uso de agentes bloqueadores neuromusculares para mejorar las condiciones durante la intubación traqueal o la laringoscopia directa en adultos y adolescentes

Appendices

Appendix 1. Cormack and Lehane classification

Difficult laryngoscopy

Cormack and Lehane (Cormack 1984) classification

Grade 1: full view of the glottis.

Grade 2: partial view of the glottis or arytenoids.

Grade 3: only epiglottis visible.

Grade 4: neither glottis nor epiglottis visible.

Laryngoscopy grade 3 and 4 define a difficult laryngoscopy.

Modified Cormack and Lehane (Yentis 1998) classification

Grade 1: full view of the glottis.

Grade 2a: partial view of the glottis.

Grade 2b: arytenoids or posterior part of the vocal cords only just visible.

Grade 3: only epiglottis visible.

Grade 4: neither glottis nor epiglottis visible.

Laryngoscopy grades 2b, 3, and 4 define a difficult laryngoscopy.

Appendix 2. CENTRAL (the Cochrane Library) search strategy

#1 MeSH descriptor: [Neuromuscular Blocking Agents] explode all trees
#2 MeSH descriptor: [Muscle Relaxants, Central] explode all trees
#3 (suxameton or rapacuronium or mivacurium or atracurium or doxacurium or cisatracurium or vecuronium or rocuronium or pancuronium or tubocurarine or gallamine or pipecuronium):ti,ab)
#4 #1 or #2 or #3
#5 MeSH descriptor: [Laryngoscopy] explode all trees
#6 MeSH descriptor: [Intubation, Intratracheal] explode all trees
#7 (difficult near (intubat* or laryngoscopy or airway))
#8 (Intubation near (score or scale))
#9 Cormack or Lehane
#10 ((tracheal near intub*) or airway or laryngoscopy):ti
#11 #5 or #6 or #7 or #8 or #9 or #10
#12 #4 and #11

Appendix 3. MEDLINE (Ovid SP) search strategy

1     exp Neuromuscular Blocking Agents/ or Muscle Relaxants, Central/ or (suxamethonium or rapacuronium or mivacurium or atracurium or doxacurium or cisatracurium or vecuronium or rocuronium or pancuronium or tubocurarine or gallamine or pipecuronium).ti,ab.

2     Laryngoscopy/ or Intubation, Intratracheal/ or (difficult adj3 (intubat* or laryngoscopy or airway)).mp. or ((Intubation adj3 (score or scale)) or (Cormack or Lehane)).mp. or ((tracheal adj3 intub*) or airway or laryngoscopy).ti.

3     1 and 2

4     ((randomized controlled trial or controlled clinical trial).pt. or randomized.ab. or placebo.ab. or drug therapy.fs. or randomly.ab. or trial.ab. or groups.ab.) not (animals not (humans and animals)).sh.

5     3 and 4

Appendix 4. Embase (Ovid SP) search strategy

1. exp neuromuscular blocking agent/ or central muscle relaxant/ or (suxameton or rapacuronium or mivacurium or atracurium or doxacurium or cisatracurium or vecuronium or rocuronium or pancuronium or tubocurarine or gallamine or pipecuronium).ti,ab.

2. laryngoscopy/ or endotracheal intubation/ or (difficult adj3 (intubat* or laryngoscopy or airway)).mp. or ((Intubation adj3 (score or scale)) or (Cormack or Lehane)).mp. or ((tracheal adj3 intub*) or airway or laryngoscopy).ti.

3. 1 and 2

4. (placebo.sh. or controlled study.ab. or random*.ti,ab. or trial*.ti,ab. or ((singl* or doubl* or trebl* or tripl*) adj3 (blind* or mask*)).ti,ab.) not (animals not (humans and animals)).sh.

5. 3 and 4

Appendix 5. BIOSIS Citation Index

#1 TS=Neuromuscular Blocking or TS=Muscle Relaxant* or TS=(suxameton or rapacuronium or mivacurium or atracurium or doxacurium or cisatracurium or vecuronium or rocuronium or pancuronium or tubocurarine or gallamine or pipecuronium)

#2 TS=(Cormack or Lehane) or TS=(difficult SAME (intubat* or laryngoscopy or airway)) or TS=(Intubation SAME (score or scale)) or TI=((tracheal and intub*) or airway or laryngoscopy)

#3 #2 AND #1

#4 TS=(random* or (controlled SAME (study or trial*)) or prospective or placebo or multicenter) or TS=((mask* or blind*) SAME (single or double or triple or treble))

#5 #3 and #4

Appendix 6. CINAHL (EBSCO) search strategy

S1 ((MH "Neuromuscular Blocking Agents") OR (MH "Muscle Relaxants, Central") ) OR AB ( suxameton or rapacuronium or mivacurium or atracurium or doxacurium or cisatracurium or vecuronium or rocuronium or pancuronium or tubocurarine or gallamine or pipecuronium)
S2 ((MH "Laryngoscopy") OR (MH "Intubation, Intratracheal")) OR ((difficult and (intubat* or laryngoscopy or airway))) OR ( (Intubation and (score or scale))) OR (Cormack or Lehane) OR TI ((tracheal and intub*) or airway or laryngoscopy)
S3 S2 and S1

Appendix 7. LILACS (BIREME) serach strategy

((Neuromuscular Blocking Agent$) or Muscle Relaxant$ or (suxameton or rapacuronium or mivacurium or atracurium or doxacurium or cisatracurium or vecuronium or rocuronium or pancuronium or tubocurarine or gallamine or pipecuronium)) and ((Cormack or Lehane) or (difficult and (intubate$ or laryngoscopy or airway)) or (Intubation and (score or scale)) or ((tracheal and intub$) or airway or laryngoscopy))

Appendix 8. Data extraction form

Study selection, quality assessment, and data extraction form

 

First study author

Journal/Conference proceedings, etc.

Year

 

 

 

 

Study eligibility

 

RCT

Relevant participants

Relevant interventions

Relevant outcomes

 

Yes/No/Unclear

 

Yes/No/Unclear

 

Yes/No/Unclear

 

Yes/No*/Unclear

 

Issue relates to selective reporting when study authors may have taken measurements for particular outcomes, but not reported these within the paper(s). Review authors should contact trialists for information on possible non‐reported outcomes and reasons for exclusion from publication. Study should be listed in ‘Studies awaiting assessment’ until clarified. If no clarification is received after three attempts, study should then be excluded.

 

Do not proceed if any of the above answers are ‘No’. If study is to be included in ‘Excluded studies’ section of the review, record below the information to be inserted into the ‘Table of excluded studies’.

 

 

 

 

Freehand space for comments on study design and treatment:

References to trial

 

Check other references identified in searches. If further references to this trial are available, link the papers now and list below. All references to a trial should be linked under one Study ID in RevMan.

 

Code each paper

Study author(s)

Journal/Conference proceedings, etc.

Year

A

The paper listed above

 

 

B

Further papers

 

 

C

 

 

 

D

 

 

 

E

 

 

 

Participants and trial characteristics

 

Participant characteristics

Covariate

Further details

Age (mean, median, range, etc.)

 

Sex of participants (numbers/%, etc.)

 

BMI (mean, median, range, etc.)

 

Trial characteristics

 

Methodological quality

Random sequence generation

State here method used to generate random sequence and reasons for grading

Grade (circle)

 

 

Low risk of bias (random)

High risk of bias (e.g. alternate)

Unclear

 

Allocation concealment

Process used to prevent foreknowledge of group assignment in an RCT, which should be seen as distinct from blinding

State here method used to conceal allocation and reasons for grading

Grade (circle)

 

Low risk of bias

High risk of bias

Unclear

Blinding

 

Person responsible for participant care

Low risk/High risk/Unclear risk

 

Participant

Low risk/High risk/Unclear risk

 

Outcome assessor

Low risk/High risk/Unclear risk

 

Other (please specify)

Low risk/High risk/Unclear risk

 

Incomplete outcome data

 

Low risk, if numbers and reasons for dropouts and withdrawals in the intervention groups were described, or if it was specified that no dropouts or withdrawals occurred

Yes/No

 

High risk, if numbers or reasons for dropouts and withdrawals were not described

Yes/No

 

Unclear, if the report gave the impression that no dropouts or withdrawals had occurred, but did not specifically state this

Yes/No

 

Selective reporting

 

Low risk, if predefined or clinically relevant and reasonably expected outcomes are reported

Yes/No

 

High risk, if one or more clinically relevant and reasonably expected outcomes were not reported; data on these outcomes were likely to have been recorded

Yes/No

 

Unclear, if not all predefined or clinically relevant and reasonably expected outcomes are reported, or if they are not reported fully, or if it is unclear whether data on these outcomes were recorded

Yes/No

 

Baseline imbalance

 

Low risk, if no baseline imbalance in important characteristics is evident

Yes/No

 

High risk, if a baseline imbalance is due to chance or is due to imbalanced exclusion after randomization

Yes/No

 

Unclear, if baseline characteristics were not reported

Yes/No

 

Early stopping

 

Low risk, if sample size calculation was reported and the trial was not stopped, or if the trial was stopped early by formal stopping rules at a point when the likelihood of observing an extreme intervention effect due to chance was low

Yes/No

 

High risk, if the trial was stopped early owing to informal stopping rules, or if the trial was stopped early by a formal stopping rule at a point when the likelihood of observing an extreme intervention effect due to chance was high

Yes/No

 

Unclear, if sample size calculation was not reported and it is not clear whether the trial was stopped early

Yes/No

 

Other bias

 

Low risk of bias, if the trial appears to be free of other components that could put it at risk of bias

Yes/No

 

High risk of bias, if other factors in the trial could put it at risk of bias (e.g. ’for‐profit’ involvement, authors have conducted trials on the same topic)

Yes/No

 

Unclear, if the trial may or may not be free of other components that could put it at risk of bias

Yes/No

 

Modified intention‐to‐treat

A modified intention‐to‐treat analysis is one in which all participants in a trial are operated and analysed according to the intervention to which they were allocated, whether or not they received it

 

 

All participants entering trial after surgery

 

15% or fewer excluded

 

 

More than 15% excluded

 

 

Not analysed as modified ‘intention‐to‐treat’

 

 

Unclear

 

 

 

 

 

Were withdrawals described?    Yes  ?         No ?                  Not clear  ?  

Discuss if appropriate

 

Trial characteristics

 

Further details

Single‐centre/Multi‐centre

 

Country/Countries

 

How was participant eligibility defined?

 

 

How many participants were randomized?

 

Number of intervention groups/number of control groups

 

Number of participants in each intervention group/Number of participants in each control group

 

Number of participants who received intended intervention (per‐protocol population)

 

Number of participants who were analysed

 

Type of outcome measure (DTI/DL?)

 

 

NMBA: type and dose?

 

Hypnotic: type and dose

 

Opioid: type and dose

 

Local anaesthetic: type and dose

 

Other

 

* If cross‐over design, please refer to the Cochrane Editorial Office for further advice on how to analyse these data

 

Other design characteristics of the trial

1. Mallampati score (predicts DTI/DL Yes/No??)

2. Thyromental distance (predicts DTI/DL Yes/No??) or (cm)

3. Neck extension (predicts DTI/DL Yes/No??) or (degrees)

4. Mouth opening/Interincisor gap (predicts DTI/DL Yes/No??) or (cm)

5. Mandible subluxation (predicts DTI/DL Yes/No??)

6. Time from induction to start of tracheal intubation (seconds)

Data extraction

 

Outcomes

Available for the trial

1.1 Difficult tracheal intubation

Yes/No

1.2 Overall mortality. We will use the maximal follow‐up data from each trial

Yes/No

1.3. One or more events of upper airway discomfort/injury (e.g. sore throat, hoarseness, vocal cord lesion, minor pharyngeal injury)

Yes/No

2.1. One or more major serious events: gastric aspiration, brain and heart injuries (e.g. caused by anoxia, hypotension, bradycardia/tachycardia during tracheal intubation)

Yes/No

2.2 Difficult laryngoscopy

Yes/No

For continuous data

 

Code of paper

 

 

Outcomes (rename)

 

 

Unit of measurement

Intervention group

Control group

Details if outcome described only in text

n

Mean (SD)

n

Mean (SD)

 

A

1.1 Difficulty of tracheal intubation

Score

 

 

 

 

 

For dichotomous data

Code of paper

Outcomes

Intervention group E/N

E = number of events

N = number of participants

Control group E/N

E = number of events

N = number of  participants

A

1.1 Difficult tracheal intubation

 

 

 

1.2 Overall mortality. We will use the maximal follow‐up data from each trial

 

 

 

1.3. One or more events of upper airway discomfort/injury (e.g. sore throat, hoarseness, vocal cord lesion, minor pharyngeal injury)

 

 

 

2.1. One or more major serious events: gastric aspiration, brain and heart injuries (e.g. caused by anoxia, hypotension, bradycardia/tachycardia during tracheal intubation)

 

 

2.2 Difficult laryngoscopy

Other information that you believe is relevant to the results

Indicate if any data were obtained from the primary author; if results were estimated from graphs, etc. or were calculated by using a formula (this should be stated and the formula given). In general, if results not reported in paper(s) are obtained, this should be made clear here to be cited in the review

 

 

 

Mallampati score

Predicts DTI/DL (numbers/% of participants)

Thyromental distance

Predicts DTI/DL (numbers/% of participants)

cm (mean, median, range, etc.)

Neck extension

Predicts DTI/DL (numbers/% of participants)

degrees (mean, median, range, etc.)

Mouth opening/Interincisor gap

Predicts DTI/DL (numbers/% of participants)

cm (mean, median, range, etc.)

Mandible subluxation

Predicts DTI/DL (numbers/% of participants)

Time from induction to start of tracheal intubation

seconds (mean, median, range, etc.)

 

 

Freehand space for writing actions such as contact with study authors and changes

References to other trials

 

Did this report include any references to published reports of potentially eligible trials not already identified for this review?

First study author

Journal/Conference

Year of publication

 

 

 

Did this report include any references to unpublished data from potentially eligible trials not already identified for this review? If yes, list contact names and details

Study flow diagram.
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Figure 1

Study flow diagram.

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Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Funnel plot of comparison: 1 Avoidance vs use of NMBA, outcome: 1.1 Difficult tracheal intubation: low risk of bias vs high or uncertain risk of bias.
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Figure 3

Funnel plot of comparison: 1 Avoidance vs use of NMBA, outcome: 1.1 Difficult tracheal intubation: low risk of bias vs high or uncertain risk of bias.

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original image
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Figure 4
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Figure 5
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Figure 6
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Comparison 1 Avoidance vs use of NMBA, Outcome 1 Difficult tracheal intubation: low risk of bias vs high or uncertain risk of bias.
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Analysis 1.1

Comparison 1 Avoidance vs use of NMBA, Outcome 1 Difficult tracheal intubation: low risk of bias vs high or uncertain risk of bias.

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Comparison 1 Avoidance vs use of NMBA, Outcome 2 Difficult tracheal intubation: depolarizing vs non‐depolarizing NMBA.
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Analysis 1.2

Comparison 1 Avoidance vs use of NMBA, Outcome 2 Difficult tracheal intubation: depolarizing vs non‐depolarizing NMBA.

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Comparison 1 Avoidance vs use of NMBA, Outcome 3 Difficult tracheal intubation: remifentanil vs no remifentanil.
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Analysis 1.3

Comparison 1 Avoidance vs use of NMBA, Outcome 3 Difficult tracheal intubation: remifentanil vs no remifentanil.

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Comparison 1 Avoidance vs use of NMBA, Outcome 4 Difficult tracheal intubation: alfentanil vs no alfentanil.
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Analysis 1.4

Comparison 1 Avoidance vs use of NMBA, Outcome 4 Difficult tracheal intubation: alfentanil vs no alfentanil.

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Comparison 1 Avoidance vs use of NMBA, Outcome 5 Difficult tracheal intubation: local anaesthesia vs no local anaesthesia.
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Analysis 1.5

Comparison 1 Avoidance vs use of NMBA, Outcome 5 Difficult tracheal intubation: local anaesthesia vs no local anaesthesia.

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Comparison 1 Avoidance vs use of NMBA, Outcome 6 Difficult tracheal intubation: excluded anticipated DTI vs included anticipated DTI.
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Analysis 1.6

Comparison 1 Avoidance vs use of NMBA, Outcome 6 Difficult tracheal intubation: excluded anticipated DTI vs included anticipated DTI.

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Comparison 1 Avoidance vs use of NMBA, Outcome 7 Difficult tracheal intubation: "best‐case scenario".
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Analysis 1.7

Comparison 1 Avoidance vs use of NMBA, Outcome 7 Difficult tracheal intubation: "best‐case scenario".

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Comparison 1 Avoidance vs use of NMBA, Outcome 8 Difficult tracheal intubation excluding dose‐finding studies.
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Analysis 1.8

Comparison 1 Avoidance vs use of NMBA, Outcome 8 Difficult tracheal intubation excluding dose‐finding studies.

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Comparison 1 Avoidance vs use of NMBA, Outcome 9 Difficult tracheal intubation: funding from pharmaceutical industry.
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Analysis 1.9

Comparison 1 Avoidance vs use of NMBA, Outcome 9 Difficult tracheal intubation: funding from pharmaceutical industry.

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Comparison 1 Avoidance vs use of NMBA, Outcome 10 One or more events of upper airway discomfort or injury: low risk of bias vs high or uncertain risk of bias.
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Analysis 1.10

Comparison 1 Avoidance vs use of NMBA, Outcome 10 One or more events of upper airway discomfort or injury: low risk of bias vs high or uncertain risk of bias.

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Comparison 1 Avoidance vs use of NMBA, Outcome 11 One or more events of upper airway discomfort or injury: depolarizing vs non‐depolarizing NMBA.
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Analysis 1.11

Comparison 1 Avoidance vs use of NMBA, Outcome 11 One or more events of upper airway discomfort or injury: depolarizing vs non‐depolarizing NMBA.

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Comparison 1 Avoidance vs use of NMBA, Outcome 12 One or more events of upper airway discomfort or injury: remifentanil vs no remifentanil.
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Analysis 1.12

Comparison 1 Avoidance vs use of NMBA, Outcome 12 One or more events of upper airway discomfort or injury: remifentanil vs no remifentanil.

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Comparison 1 Avoidance vs use of NMBA, Outcome 13 One or more events of upper airway discomfort or injury: alfentanil vs no alfentanil.
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Analysis 1.13

Comparison 1 Avoidance vs use of NMBA, Outcome 13 One or more events of upper airway discomfort or injury: alfentanil vs no alfentanil.

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Comparison 1 Avoidance vs use of NMBA, Outcome 14 One or more events of upper airway discomfort or injury: excluded anticipated DTI vs included anticipated DTI.
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Analysis 1.14

Comparison 1 Avoidance vs use of NMBA, Outcome 14 One or more events of upper airway discomfort or injury: excluded anticipated DTI vs included anticipated DTI.

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Comparison 1 Avoidance vs use of NMBA, Outcome 15 Difficult laryngoscopy: low risk of bias vs high or uncertain risk of bias.
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Analysis 1.15

Comparison 1 Avoidance vs use of NMBA, Outcome 15 Difficult laryngoscopy: low risk of bias vs high or uncertain risk of bias.

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Summary of findings for the main comparison. Summary of findings table: primary and secondary outcomes

Avoidance vs use of neuromuscular blocking agent for improving conditions during tracheal intubation in adults and adolescents

Patient or population: improving conditions during tracheal intubation or direct laryngoscopy in adults and adolescents
Setting: people undergoing various surgical procedures in hospital departments. Most trials were conducted in high‐income countries, and most participants were undergoing elective surgery. Participants of both genders were included; most were ASA class I or II, were non‐obese, and had no expected airway management difficulties
Intervention: avoidance of NMBA
Comparison: use of NMBA

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

of avoidance vs use of NMBA

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Risk with use of NMBA

Corresponding risk

Risk with avoidance of NMBA

Primary outcomes

Difficult tracheal intubation: low risk of bias trials

Study population

RR 13.27
(8.19 to 21.49)

508
(4 studies)

⊕⊕⊕⊝

Moderatea

TSA shows that the required information size of 8195 for a 20% RRR has not been achieved, but the trial sequential monitoring boundary has been crossed and the TSA‐adjusted CI for the RR is 1.85 to 95.04

47 per 1000

620 per 1000
(383 to 1000)

Difficult tracheal intubation: all trials

Study population

RR 5.00
(3.49 to 7.15)

3565
(34 studies)

⊕⊕⊝⊝

Lowb

TSA shows that the required information size of 44,661 for a 20% RRR has not been achieved, but the trial sequential monitoring boundary has been crossed and the TSA‐adjusted CI for the RR is 1.20 to 20.77.

81 per 1000

406 per 1000
(284 to 597)

One or more events of upper airway discomfort or injury: low risk of bias trials

Study population

RR 2.74
(1.21 to 6.21)

73
(1 study)

See comments

Because only 1 low risk of bias trial was identified, no quality of evidence assessment was performed

162 per 1000

444 per 1000
(196 to 1000)

One or more events of upper airway discomfort or injury: all trials

Study population

RR 1.37
(1.09 to 1.74)

846
(7 studies)

⊕⊕⊕⊝

Moderatec

TSA shows that the required information size of 1981 for a 20% RRR has not been achieved, but the trial sequential monitoring boundary has been crossed and the TSA‐adjusted CI for the RR is 1.00 to 1.86.

273 per 1000

374 per 1000
(298 to 475)

Mortality

Not estimated

Not estimated

Not estimated

0 (34 studies)

Not estimated

Secondary outcomes

Difficult laryngoscopy: low risk of bias trials

Study population

RR 4.00
(0.47 to 34.20)

78
(1 study)

See comments

Because only 1 low risk of bias trial was identified, no quality of evidence assessment was performed

26 per 1000

103 per 1000
(12 to 877)

Difficult laryngoscopy: all trials

Study population

RR 2.54
(1.53 to 4.21)

1308
(13 studies)

⊕⊕⊝⊝

Lowd

TSA shows that the required information size of 22,911 for a 20% RRR was not achieved, and in no trials were sequential monitoring boundaries crossed. The TSA‐adjusted CI for the RR is 0.27 to 21.75.

33 per 1000

85 per 1000
(51 to 141)

*The risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI = confidence interval; RR = risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to the estimate of effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

aDowngraded one level because of indirectness

bDowngraded two levels because of indirectness, heterogeneity, and high or uncertain risk of bias

cDowngraded one level because of high or uncertain risk of bias

dDowngraded two levels because of imprecision and high or uncertain risk of bias

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Summary of findings for the main comparison. Summary of findings table: primary and secondary outcomes
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Table 1. Baseline

Study ID

NMBA

Country

Language

Randomized

Sex

Age, years

Weight, kg

BMI

ASA

class

included

Expected

difficult

airway excluded

Overweight

excluded

Alexander 1999

C1: suxamethonium 1 mg/kg

UK

English

60

C: 12F/8M

I1: 11F/9M

I2: 11F/9M

C: 41.7 (17.4)

I1: 40.3 (10.6)

I2: 44.2 (15.0)

C: 76.3 (15.0)

I1: 75.5 (15.1)

I2: 76.6 (16.8)

ns

I‐II

yes

Barclay 1997

C1: rocuronium 0.1 mg/kg

C2: rocuronium 0.13 mg/kg

UK

English

60

ns

C1: 30

C2: 29

I1: 27

C1: 74

C2: 72

I1: 64

ns

ns

yes

yes

Beck 1993

C1: suxamethonium 1 mg/kg

USA

English

64

C1: 22F/11M

I1: 21F/10M

C1: 34 (11)

I1: 35 (11)

C1: 69 (14)

I1: 65 (13)

I‐II

Bouvet 2008

C1: cisatracurium 0.15 mg/kg

France

English

130

C1: 65F

I1: 65F

C1: 41.5 (12.9)

I1: 40.7 (15.2)

ns

C1: 24.6 (5.4)

I1: 23.0 (3.5)

I‐II

yes

Combes 2007

C1: rocuronium 0.6 mg/kg

France

English

300

C1: 73F/77M

I1: 69F/81M

C1: 41 (18‐70)

I1: 43 (18‐66)

C1: 73 (13)

I1: 70 (13)

ns

I‐II

yes

yes

Dominici 1990

C1: suxamethonium 1.5 mg/kg

France

French

60

C1: 9F/21M

I1: 9F/21M

C1: 48.4 (3.4)

I1: 50.1 (2.9)

C1: 62.8 (2.5)

I1: 61.6 (2.1)

ns

I‐III

González Obregón 2010

C1: rocuronium 0.6 mg/kg

Columbia

Spanish

100

C1: 33F/17M

I1: 33F/17M

C1: 34.7 (11.0)

I1: 32.8 (12.3)

ns

ns

I‐II

yes

Gulhas 2013

C1: succinylcholine 1 mg/kg

Turkey

English

80

C1: 19F/21M

I1: 22F/18M

C1: 49.6 (8.4)

I1: 47.9 (8.7)

C1: 77.3 (13.1)

I1: 73.2 (14.4)

ns

I‐II

Hanna 2010

C1: rocuronium 0.06 mg/kg

+ succinylcholine 1.5 mg/kg

USA

English

50

C1: 15F/9M

I1: 5F/18M

C1: 39.0 (13.3)

I1: 43.0 (14.5)

C1: 75.0 (15.0)

I1: 81.0 (13.0)

C1: 25.9 (4.6)

I1: 26.5 (2.9)

I‐II

yes

Harsten 1997

C1: suxamethonium 1 mg/kg

Sweden

English

80

C1: 26F/13M

I1: 23F/14M

C1: 41.8 (13)

I1: 39.5 (14)

ns

ns

I‐II

Iamaroon 2001

C1: suxamethonium 1.5 mg/kg

Thailand

English

120

C1: 54F/6M

I1: 54F/6M

C1: 40.6 (9.1)

I1: 39.7 (9.2)

C1: 55.8 (10.8)

I1: 55.1 (9.1)

ns

I‐II

yes

yes

Isesele 2012

C1: suxamethonium 1.5 mg/kg

Nigeria

English

96

C1: 12F/32M

I1: 21F/23M

C1: 30.8 (9.0)

I1: 32.6 (8.0)

C1. 69.0 (7.4)

I1: 68.3 (6.6)

I‐II

yes

Jiao 2014

C1: suxamethonium 0.6 mg/kg

China

English

55

C1: 27F/0M

I1: 28F/0M

C1: 38.4 (10.9)

I2: 36.3 (9.9)

C1: 58.1 (7.0)

I2: 58.2 (7.9)

ns

I‐II

yes

Kahwaji 1997

C1: ORG 9487 (rapacuronium) 0.5 mg/kg

C2: ORG 9487 (rapacuronium) 1.0 mg/kg

C3: ORG 9487 (rapacuronium) 1.5 mg/kg

C4: ORG 9487 (rapacuronium) 2.0 mg/kg

C5: ORG 9487 (rapacuronium) 2.5 mg/kg

USA

English

181

C1: 20F/10M

C2: 18F/9M

C3: 17F/15M

C4: 15F/13M

C5: 22F/9M

I1: 19F/11M

C1: 51.3

C2: 49.6

C3: 52.0

C4: 50.6

C5: 50.2

I1: 52.6

C1: 67.3

C2: 70.5

C3: 68.6

C4: 71.3

C5: 75.9

I1: 69.7

ns

I‐III

yes

Kirkegaard‐Nielsen 1999

C1: rocuronium 0.4 mg/kg

C2: rocuronium 0.8 mg/kg

C3: rocuronium 1.2 mg/kg

USA

English

80

C1: 2F/18M

C2: 6F/14M

C3: 10F/10M

I1: 5F/15M

C1: 39.7 (7.5)

C2: 39.5 (14.3)

C3: 39.2 (10.5)

I1: 39.3 (11.8)

C1: 75.0 (16.9)

C2: 78.6 (15.8)

C3: 67.4 (14.8)

I1: 73.4 (16.6)

ns

I‐II

yes

Kopman 2001

C1: rapacuronium 1.0 mg/kg

C2: rapacuronium 1.2 mg/kg

C3: rocuronium 0.50 mg/kg

USA

English

100

ns

range:

18‐65

ns

range:

17.5‐27.5

I‐II

yes

Lieutaud 2003

C1: atracurium 0.5 mg/kg

C2: atracurium 0.5 mg/kg

C3: atracurium 0.5 mg/kg

France

English

170

C1: 3F/42M

C2: 7F/41M

C3: 8F/39M

I1: 2F/18M

C1: 52.9 (11.8)

C2: 51.3 (12.6)

C3: 56.3 (11.9)

I1: 50.4 (10.7)

ns

C1: 23.7 (3.2)

C2: 23.1 (3.2)

C3: 23.6 (3.4)

I1: 23.3 (3.9)

I‐II

yes

Lowry 1999

C1: rocuronium 0.3 mg/kg

C2: rocuronium 0.45 mg/kg

C3: rocuronium 0.6 mg/kg

C4: rocuronium 0.3 mg/kg

C5: rocuronium 0.45 mg/kg

C6: rocuronium 0.6 mg/kg

UK

English

140

C1: 4F/16M
C2: 7F/13M
C3: 12F/8M
C4: 9F/11M
C5: 9F/11M
C6: 4F/16M

I1: 2F/8M

I2: 4F/6M

C1: 29 (11)
C2: 40 (14)
C3: 36 (12)
C4: 33 (12)
C5: 30 (12)
C6: 33 (13)

I1: 29 (11)

I2: 30 (9)

C1: 77(16)
C2: 75 (14)
C3: 69 (14)
C4: 72 (12)
C5: 73 (14)
C6: 74 (14)

I1: 72 (12)

I2: 73 (15)

ns

I‐II

yes

yes

McNeil 2000

C1: succinylcholine 1 mg/kg

UK

English

60

ns

C1: 44 (15)

I1: 39 (11)

I2: 40 (13)

C1: 75 (10)

I1: 76 (15)

I2: 71 (12)

ns

I‐II

yes

yes

Mencke 2003

C1: atracurium 0.5 mg/kg

Germany

English

80

C1: 19F/18M

I1: 18F/18M

C1: 47.2 (13.2)

I1: 47.7 (14.3)

C1: 77.7 (16)

I1: 74.2 (15)

I‐II

yes

yes

Mencke 2014

I1: rocuronium 0.45 mg·kg‐1

Germany

English

83

C1: 16F/24M

I1: 16F/23M

C1: 50 (16)

I1: 48 (17)

C1: 83.8 (16)

I1: 79.6 (15)

C1: 28.2 (4.3)

I1: 26.5 (3.7)

I‐III

yes

yes

Naguib 2003

C1: succinylcholine 0.3 mg/kg

C2: succinylcholine 0.5 mg/kg

C3: succinylcholine 1.0 mg/kg

Saudi

Arabia

English

200

C1: 25F/25M

C2: 23F/27M

C3: 28F/22M

I1: 23F/27M

C1: 30.9 (28‐34)
C2: 30.5 (27‐34)
C3: 30.0(28‐32)
I1: 29.5 (27‐32)

C1: 66.6 (64‐70)
C2: 67.4 (64‐71)
C3: 67.8 (65‐71)
I1: 67.4 (64‐71)

ns

I

yes

Naguib 2006

C1: succinylcholine 0.3 mg/kg

C2: succinylcholine 0.5 mg/kg

C3: succinylcholine 1.0 mg/kg

C4: succinylcholine 1.5 mg/kg

C5: succinylcholine 2.0 mg/kg

Saudi

Arabia

English

180

C1: 17F13M
C2: 19F/11M
C3: 13F/17M
C4: 14F/16M
C5: 18F/12M

I1: 19F/11M

C1: 33.5 (8.7)
C2: 29.7 (8.8)
C3: 28.3 (7.9)
C4: 31.5 (9.6)
C5: 33.8 (14.8)
I1: 20.1 (8.8)

C1: 67.8 (10.3)
C2: 67.3 (10.8)
C3: 71.1 (14.2)
C4: 72.9 (12.5)
C5: 70.9 (14.5)
I1: 67.4 (10.7)

C1: 25.6 (2.8)
C2: 25.6 (3.2)
C3: 25.9 (3.9)
C4: 26.2 (3.2)
C5: 25.7 (3.9)
I1: 25.7 (3.4)

I

yes

Nimmo 1995

C1: suxamethonium 0.25 mg/kg

C2: suxamethonium 0.5 mg/kg

USA

English

60

C1: 12F/8M

C2: 12F/8M

I1: 14F/6M

C1: 28.6 (17‐55)

C2: 29.0 (16‐53)

I1: 27.0 (18‐53)

C1: 66.2 (13.6)

C2: 64.4 (11.2)

I1: 68.1 (13.6)

ns

I‐II

Pang 2014

C1: cisatracurium 0.1 mg/kg

China

English

40

C1: 14F/6M

I1: 9F/11M

C1: 45.2 (7.4)

I1: 43.3 (6.7)

C1: 63.8 (9.5)

I1: 64.6 (7.9)

C1: 23.7 (2.8)

I1: 23.3 (3.1)

I‐II

yes

yes

Pino 1998

C1: mivacurium 0.25 mg/kg

C2: rocuronium 0.45 mg/kg

C3: rocuronium 0.6 mg/kg

C4: rocuronium 0.9 mg/kg

C5: rocuronium 1.2 mg/kg

USA

English

100

ns

ns

ns

ns

I‐II

yes

yes

Rousseau 1995

C1: vecuronium 0.08 mg/kg

France

French

152

ns

C1: 23 (5)

I1: 25 (8)

C1: 71 (10)

I1: 71 (11)

ns

I

yes

Scheller 1992

C1: d‐tubocurarine 3 mg and succinylcholine 1 mg/kg

USA

English

75

C1: 8F/7M

I1: 10F/5M

I2: 11F/4M

I3: 13F/2M

I4: 10F/5M

C1: 37 (10)

I1: 33 (9)

I2: 30 (10)

I3: 35 (11)

I4: 36 (16)

C1: 77 (20)

I1: 65 (11)

I2: 66 (15)

I3: 66 (12)

I4: 68 (16)

ns

I

yes

Schlaich 2000

C1: rocuronium 0.6 mg/kg

C2: rocuronium 0.45 mg/kg

C3: rocuronium 0.3 mg/kg

Germany

English

120

C1: 13F/17M

C2: 13F/17M

C3: 14F/16M

I1: 14F/16M

C1: 37 (11)

C2: 35 (11)

C3: 36 (12)

I1: 37 (11)

C1: 72 (14)

C2: 75 (13)

C3: 75 (12)

I1: 70 (14)

ns

I‐II

yes

Sivalingam 2001

C1: suxamethonium 1 mg/kg

New Zealand

English

100

C1: 7F/18M

I1: 9F/16M

I2: 8F/17M

I3: 10F/15M

C1: 34.3 (14.0)

I1: 36.8 (12.6)

I2: 29.6 (9.7)

I3: 37.7 (12)

C1: 66 (10)

I1: 62 (11)

I2: 63 (15)

I3: 61 (11)

ns

I‐II

yes

Stevens 1997

C1: d‐tubocurarine 3 mg and succinylcholine 1 mg/kg

USA

English

140

C1: 12F/8M

I1: 12F/8M

I2: 15F/5M

I3: 17F/3M

I4: 17F/3M

I5: 15F/5M

I6: 14F/6M

C1: 35 (9)

I1: 38 (12)

I2: 34 (11)

I3: 37 (10)

I4: 34 (9)

I5: 33 (11)

I6: 37 (14)

C1: 70 (8)

I1: 72 (17)

I2: 70 (14)

I3: 72 (10)

I4: 72 (13)

I5: 72 (18)

I6: 70 (13)

ns

I‐II

yes

yes

Striebel 1995

C1: vecuronium 1 mg + succinylcholine 1 mg/kg

C2: vecuronium 1 mg + succinylcholine 1 mg/kg

Germany

German

100

C1: 25F

C2: 25F

I1: 25F

I2: 25F

C1: 47.8 (11.7)

C2: 43.8 (9.5)

I1: 46.5 (12.7)

I2: 46.0 (12.4)

C1: 62.6 (9.4)

C2: 68.2 (14)

I1: 64.9 (10.1)

I2: 70.8 (14.6)

ns

I‐II

Wong 1996

C1: succinylcholine 1 mg/kg

Malaysia

English

120

C1: 16F/14M

I1: 13F/17M

I2: 18F/12M

I3: 12F/17M

C1: 35.7 (16)

I1: 35.5 (12)

I2: 35.4 (13)

I3: 35.7 (11)

C1: 60.2 (8.9)

I1: 66.0 (13.1)

I2: 63.4 (12.9)

I3: 60.1 (10.8)

ns

I‐II

yes

Yazdi 2016

C1: atracurium 0.5 mg/kg

Iran

English

66

69.7% M

31.6 (13)

ns

ns

I‐II

yes

ns = not specified; The values in parentheses are standard deviation or range
Figuras y tablas -
Table 1. Baseline
Ir a la tabla de la revisión
Table 2. Intervention

Study ID

NMBA

Randomized/

Analysed

Hypnotic

Opioid

Local

anaesthetic

Difficult

intubation

events/
total

Difficult

laryngos‐

copy

events/
total

Upper airway

discomfort or injury

events/total

Alexander 1999

C1: suxamethonium 1 mg/kg

60/60

C1: propofol 2 mg/kg

I1: propofol 2 mg/kg

I2: propofol 2 mg/kg

C1: none

I1: alfentanil 50 μg/kg

I2: remifentanil 2 μg/kg

None

C1: 0/20

I1: 3/20

I2: 13/20

ns

ns

Barclay 1997

C1: rocuronium 0.1 mg/kg

C2: rocuronium 0.3 mg/kg

60/60

C1: propofol 2.5 mg/kg

C2: propofol 2.5 mg/kg

I1: propofol 2.5 mg/kg

C1: alfentanil 10 μg/kg

C2: alfentanil 10 μg/kg

I1: alfentanil 10 μg/kg

Lidocaine 10 mg IV

C1: 14/20

C2: 2/20

I1: 19/20

ns

ns

Beck 1993

C1: suxamethonium 1 mg/kg

64/64

C1: thiopenthal 5 mg/kg

I1: propofol 2 mg/mL

C1: none

I1: alfentanil 50 μg/kg

None

C1: 0/33

I1: 1/31

C1: 0/33

I1: 1/31

ns

Bouvet 2008

C1: cisatracurium 0.15 mg/kg

130/129

C1: propofol 2.5 mg/kg

I1: propofol 2.5 mg/kg

C1: remifentanil 2 μg/kg

I1: remifentanil 2 μg/kg

None

C1: 0/64

I1: 3/65

C1: 1/64

I1: 1/65

C1: 17/64

I1: 14/65

Combes 2007

C1: rocuronium 0.6 mg/kg

300/300

C1: propofol 2.5 mg/kg

I1: propofol 2.5 mg/kg

C1: alfentanil 15 µg/kg

I1: alfentanil 40 µg/kg

None

C1: 1/150

I1: 18/150

C1: 5/150

I1: 18/150

C1: 64/150

I1: 86/150

Dominici 1990

C1: suxamethonium 1.5 mg/kg

60

C1: propofol 3 mg/mL

I1: propofol 3 mg/mL

C1: alfentanil 7‐10 µg/kg

I1: alfentanil 7‐10 µg/kg

Lidocaine (2%): IV

+ topical Lidocaine 5%

C1: 10/30

I1: 11/30

C1: 5/30

I1: 15/30

ns

González Obregón 2010

C1: rocuronium 0.6 mg/kg

100/100

C1: propofol 1‐2 mg/kg

I1: Sevoflurane 3%

+ propofol 2 mg/kg

C1: remifentanil 1‐2 μg/kg

in 1 min + 0.15 µ/kg/min

in1 min

I1: remifentanil

0.6 µ/kg/min for 5 min

None

C1: 4/50

I1: 1/50

C1: 4/50

I1: 1/50

C1: 0/50

I1: 0/50

Gulhas 2013

C1: succinylcholine 1 mg/kg

80/80

C1: propofol 2 mg/kg

I1: propofol 2 mg/kg

C1: remifentanil 1 μg/kg

I1: remifentanil 4 μg/kg

None

C1: 5/40

I1: 0/40

ns

C1: 2/40

I1: 4/40

Hanna 2010

C1: rocuronium 0.06 mg/kg

+ succinylcholine 1.5 mg/kg

50/47

C1: propofol 2 mg/kg

I1: propofol 2 mg/kg

C1: none

I1: remifentanil 4 μg/kg

Lidocaine 0.5 mg/kg IV

C1: 2/24

I1: 3/23

ns

ns

Harsten 1997

C1: suxamethonium 1 mg/kg

80/79

C1: thiopental 5 mg/kg

I1: propofol 2.5 mg/kg

C1: alfentanil 10 μg/kg

I1: alfentanil 10 μg/kg

None

C1: 0/40

I1: 6/39

C1: 0/40

I1: 2/39

ns

Iamaroon 2001

C1: suxamentonium 1.5 mg/kg

120/120

C1: thiopenthal 5 mg/kg + (N2O)

I1: sevoflurane 8%

C1: fentanyl 1.5 μg/kg

I1: fentanyl 1.5 μg/kg

None

C1: 0/60

I1: 4/60

ns

ns

Isesele 2012

C1: suxamethonium 1.5 mg/kg

96/88

C1: propofol 2.0 mg/kg

I1: propofol 2.0 mg/kg

None

C1: none

I1: lidocaine IV 1.5 mg/kg

C1: 0/44

I1: 18/44

ns

ns

Jiao 2014

C1: suxamethonium 0.6 mg/kg

55/55

C1: propofol 2 mg/kg

I1: propofol 2 mg/kg

C1: remifentanil 1 μg/kg

I1: remifentanil 1.5 μg/kg

None

C1: 1/27

I2: 13/28

ns

ns

Kahwaji 1997

C1: ORG 9487 (rapacuronium) 0.5 mg/kg

C2: ORG 9487 (rapacuronium) 1.0 mg/kg

C3: ORG 9487 (rapacuronium) 1.5 mg/kg

C4: ORG 9487 (rapacuronium) 2.0 mg/kg

C5: ORG 9487 (rapacuronium) 2.5 mg/kg

181/176

C1: thiopental 3‐6 mg/kg
C2: thiopental 3‐6 mg/kg
C3: thiopental 3‐6 mg/kg
C4: thiopental 3‐6 mg/kg
C5: thiopental 3‐6 mg/kg

I1: thiopental 3‐6 mg/kg

C1: fentanyl 0.5‐3 μm/kg
C2: fentanyl 0.5‐3 μm/kg
C3: fentanyl 0.5‐3 μm/kg
C4: fentanyl 0.5‐3 μm/kg
C5: fentanyl 0.5‐3 μm/kg

I1: fentanyl 0.5‐3 μm/kg

None

C1: 9/30
C2: 6/27
C3: 1/32
C4: 0/28
C5: 1/29

I1: 18/30

ns

ns

Kirkegaard‐Nielsen 1999

C1: rocuronium 0.4 mg/kg

C2: rocuronium 0.8 mg/kg

C3: rocuronium 1.2 mg/kg

80/80

C1: propofol 2 mg/kg

C2: propofol 2 mg/kg

C3: propofol 2 mg/kg

I1: propofol 2 mg/kg

C1: fentanyl 2 μm/kg

C2: fentanyl 2 μm/kg

C3: fentanyl 2 μm/kg

I1: fentanyl 2 μm/kg

None

C1: 9/20

C2: 2/20

C3: 1/20

I1: 13/20

ns

ns

Kopman 2001

C1: rapacuronium 1.0 mg/kg

C2: rapacuronium 1.2 mg/kg

C3: rocuronium 0.50 mg/kg

100/100

C1: propofol 2.0 mg/kg IV

C2: propofol 2.0 mg/kg IV

C3: propofol 2.0 mg/kg IV

I1: propofol 2.0 mg/kg IV

C1: alfentanil 12.5 μg/kg

C2: alfentanil 12.5 μg/kg

C3: alfentanil 12.5 μg/kg

I1: alfentanil 12.5 μg/kg

None

C1: 2/30

C2: 0/30

C3: 0/30

I1: 7/10

Lieutaud 2003

C1: atracurium 0.5 mg/kg

C2: atracurium 0.5 mg/kg

C3: atracurium 0.5 mg/kg

170/160

C1: propofol 1.5 mg/kg

C2: propofol 2.0 mg/kg

C3: propofol 2.5 mg/kg

I1: propofol 2.5 mg/kg

C1: fentanyl 3 μm/kg

C2: fentanyl 3 μm/kg

C3: fentanyl 3 μm/kg

I1: fentanyl 3 μm/kg

None

C1: 7/47

C2: 1/48

C3: 2/45

I1: 13/20

ns

ns

Lowry 1999

C1: rocuronium 0.3 mg/kg

C2: rocuronium 0.45 mg/kg

C3: rocuronium 0.6 mg/kg

C4: rocuronium 0.3 mg/kg

C5: rocuronium 0.45 mg/kg

C6: rocuronium 0.6 mg/kg

140/140

C1: propofol 2‐3 mg/kg

C2: propofol 2‐3 mg/kg

C3: propofol 2‐3 mg/kg

C4: sevoflurane 8%

C5: sevoflurane 8%

C6: sevoflurane 8%

I1: propofol 2‐3 mg/kg

I2: sevoflurane 8%

C1: fentanyl 1 μm/kg

C2: fentanyl 1 μm/kg

C3: fentanyl 1 μm/kg

C4: fentanyl 1 μm/kg

C5: fentanyl 1 μm/kg

C6: fentanyl 1 μm/kg

I1: fentanyl 1 μm/kg

I2: fentanyl 1 μm/kg

None

C1: 11/20

C2: 4/20

C3: 2/20

C4:14/20

C5: 9/20

C6: 2/20

I1:10/10

I2: 9/10

ns

ns

McNeil 2000

C1: succinylcholine 1 mg/kg

60/60

C1: propofol 2 mg/kg

I1: propofol 2 mg/kg

I2: propofol 2 mg/kg

C1: none

I1: remifentanil 2 μg/kg

I2: remifentanil 4 μg/kg

None

C1: 0/17

I1: 2/23

I2: 2/20

C1: 0/17

I1: 0/23

I2: 0/20

ns

Mencke 2003

C1: atracurium 0.5 mg/kg

80/73

C1: propofol 2.5‐3 mg/kg

I1: propofol 2.5‐3 mg/kg

C1: fentanyl 2‐3 μg/kg

I1: fentanyl 2‐3 μg/kg

None

C1: 2/37

I1: 12/36

C1: 1/39

I1: 4/39

C1: 6/37

I1: 16/36

Mencke 2014

C1: rocuronium 0.45 mg·kg/kg

83/83

C1: propofol 1.5 mg·kg‐1 + sevoflurane 3.0‐3.5 Vol%,8 l·min‐1 in 2‐3 minutes

I1: propofol 1.5 mg/kg

C1: remifentanil 0.30 μg/kg/min for 3 minutes

I1: remifentanil 0.30 μg/kg/min for 3 minutes

None

C1: 1/40

I1: 11/43

C1: 0/40

I1: 2/43

C1: 12/33

I1: 17/31

Naguib 2003

C1: succinylcholine 0.3 mg/kg

C2: succinylcholine 0.5 mg/kg

C3: succinylcholine 1.0 mg/kg

200/200

C1: propofol 2 mg/kg

C2: propofol 2 mg/kg

C3: propofol 2 mg/kg

I1: propofol 2 mg/kg

C1: fentanyl 2 μg/kg

C2: fentanyl 2 μg/kg

C3: fentanyl 2 μg/kg

I1: fentanyl 2 μg/kg

None

C1: 4/50

C2: 3/50

C3: 1/50

I1: 15/50

ns

ns

Naguib 2006

C1: succinylcholine 0.3 mg/kg

C2: succinylcholine 0.5 mg/kg

C3: succinylcholine 1.0 mg/kg

C4: succinylcholine 1.5 mg/kg

C5: succinylcholine 2.0 mg/kg

180/180

C1: propofol 2 mg/kg

C2: propofol 2 mg/kg

C3: propofol 2 mg/kg

C4: propofol 2 mg/kg

C5: propofol 2 mg/kg

I1: propofol 2 mg/kg

C1: fentanyl 2 μm/kg

C2: fentanyl 2 μm/kg

C3: fentanyl 2 μm/kg

C4: fentanyl 2 μm/kg

C5: fentanyl 2 μm/kg

I1: fentanyl 2 μm/kg

None

C1: 2/30

C2: 2/30

C3: 1/30

C4: 1/30

C5: 0/30

I1: 21/30

ns

ns

Nimmo 1995

C1: suxamethonium 0.25 mg/kg

C2: suxamethonium 0.5 mg/kg

60/60

C1: propofol 2.5 mg/kg

C2: propofol 2.5 mg/kg

I1: Propofol 2.5 mg/kg

C1: alfentanil 15 μg/kg

C2: alfentanil 15 μg/kg

I1: alfentanil 15 μg/kg

None

C1: 0/20

C2: 1/20

I1: 9/20

ns

ns

Pang 2014

C1: cisatracurium 0.1 mg/kg

20/20

C1: propofol target control

I1: propofol target control

C1: remifentanil target control

I1: remifentanil target control

C1: tetracaine 10 mg/mL

I1: tetracaine 10 mg/mL

C1: 0/20

I1: 0/20

C1: 0/20

I1: 0/20

ns

Pino 1998

C1: mivacurium 0.25 mg/kg

C2: rocuronium 0.45 mg/kg

C3: rocuronium 0.6 mg/kg

C4: rocuronium 0.9 mg/kg

C5: rocuronium 1.2 mg/kg

100/98

C1: propofol 2 mg/kg

C2: propofol 2 mg/kg

C3: propofol 2 mg/kg

C4: propofol 2 mg/kg

C5: propofol 2 mg/kg

I1: propofol 2 mg/kg

C1: fentanyl 2 μm/kg

C2: fentanyl 2 μm/kg

C3: fentanyl 2 μm/kg

C4: fentanyl 2 μm/kg

C5: fentanyl 2 μm/kg

I1: fentanyl 2 μm/kg

None

C1: 2/30

IC2: 9/15

C3: 4/14

C4: 1/14

C5: 0/15

I1: 10/10

ns

ns

Rousseau 1995

C1: vecuronium 0.08 mg/kg

152/152

C1: propofol 2.5 mg/kg

I1: propofol 2.5 mg/kg

C1: alfentanil 0.03 mg/kg

I1: alfentanil 0.03 mg/kg

C1: none

I1: lidocaine 1.5 mg/kg

C1: 2/77

I1: 4/75

ns

ns

Scheller 1992

C1: d‐tubocurarine 3 mg and succinylcholine 1 mg/kg

75/75

C1: thiamylal 4 mg/kg

I1: propofol 2 mg/kg

I2: propofol 2 mg/kg

I3: propofol 2 mg/kg

I4: propofol 2 mg/kg

C1: none

I1: alfentanil 30 µg/kg

I2: alfentanil 40 µg/kg

I3: alfentanil 50 µg/kg

I4: alfentanil 60 µg/kg

None

C1: 0/15

I1: 1/15

I2: 1/15

I3: 1/15

I4: 1/15

C1: 0/15

I1: 1/15

I2: 1/15

I3: 1/15

I4: 1/15

ns

Schlaich 2000

C1: rocuronium 0.6 mg/kg

C2: rocuronium 0.45 mg/kg

C3: rocuronium 0.3 mg/kg

120/120

C1: propofol 2‐2.5 mg/kg

C2: propofol 2‐2.5 mg/kg

C3: propofol 2‐2.5 mg/kg

I1: propofol 2‐2.5 mg/kg

C1: remifentanil 0.5 µg/kg/min

C2: remifentanil 0.5 µg/kg/min

IC3: remifentanil 0.5 µg/kg/min

I1: remifentanil 0.5 µg/kg/min

None

C1: 0/30

C2: 1/30

C3: 0/30

I1: 12/30

ns

ns

Sivalingam 2001

C1: suxamethonium 1 mg/kg

100/100

C1: Sevoflu 7% + N2O60%

I1: Sevoflu 7% + N2O60%

I2: Sevoflu 7% + N2O60%

I3: Sevoflu 7% + N2O60%

C1: alfentanil 10 µg/kg

I1: alfentanil 20 µg/kg

I2: alfentanil 25 µg/kg

I3: alfentanil 30 µg/kg

None

C1: 1/25

I1: 4/25

I2: 5/25

I3: 2/25

ns

C1: 8/25

I1: 12/25

I2: 13/25

I3: 9/25

Stevens 1997

C1: d‐tubocurarine 3 mg and succinylcholine 1 mg/kg

140/140

C1: thiopental 4 mg/kg

I1: etomidate 0.3 mg/kg

I2: etomidate 0.3 mg/kg

I3: propofol 2 mg/kg

I4: propofol 2 mg/kg

I5: thiopental 4 mg/kg

I6: thiopental 4 mg/kg

C1: none

I1: alfentanil 40 µg/kg

I2: alfentanil 40 µg/kg

I3: alfentanil 40 µg/kg

I4: alfentanil 40 µg/kg

I5: alfentanil 40 µg/kg

I6: alfentanil 40 µg/kg

C1: none

I1: none

I2: lidocaine 1 mg/kg

I3: none

I4: lidocaine 1 mg/kg

I5: none

I6: lidocaine1 mg/kg

C1: 1/20

I1: 3/20

I2: 1/20

I3: 3/20

I4: 2/20

I5: 8/20

I6: 3/20

C1: 0/20

I1: 0/20

I2: 0/20

I3: 0/20

I4: 0/20

I5: 0/20

I6: 0/20

ns

Striebel 1995

C1: vecuronium 1 mg + succinylcholine 1 mg/kg

C2: vecuronium 1 mg + succinylcholine 1 mg/kg

100/100

C1: thiopental 5.5 mg/kg

C2: propofol 2.2 mg/kg

I1: propofol 2.4 mg/kg

I2: propofol 2.2 mg/kg

C1: fentanyl 0.1 mg

C2: fentanyl 0.1 mg

I1: fentanyl 0.1 mg

I2: fentanyl 0.2 mg

2 mL lidocaine 1% IV

C1: 1/25

C2: 1/25

I1: 3/25

I2: 5/25

C1: 2/25

C2: 1/25

I1: 1/28

I2: 4/25

ns

Wong 1996

C1: succinylcholine 1 mg/kg

120/120

C1: propofol 3.0 mg/kg

I1: propofol 2.6 mg/kg

I2: propofol 2.6 mg/kg

I3: propofol 3.1 mg/kg

C1: none

I1: alfentanil 15 μg/kg

I2: alfentanil 30 μg/kg

I3: none

None

C1: 0/30

I1: 1/30

I2: 0/30

I3: 6/30

ns

ns

Yazdi 2016

C1: atracurium 0.5 mg/kg

66/66

C1: propofol 2.5 mg/kg

I1: propofol 2.5 mg/kg

C1: none

I1: remifentanil 2 μg/kg

None

C1: 4/31

I1: 14/35

ns

ns

ns = not specified
Figuras y tablas -
Table 2. Intervention
Ir a la tabla de la revisión
Comparison 1. Avoidance vs use of NMBA

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Difficult tracheal intubation: low risk of bias vs high or uncertain risk of bias Show forest plot

34

3565

Risk Ratio (M‐H, Random, 95% CI)

5.00 [3.49, 7.15]

1.1 Low risk of bias

4

508

Risk Ratio (M‐H, Random, 95% CI)

13.27 [8.19, 21.49]

1.2 High or uncertain risk of bias

30

3057

Risk Ratio (M‐H, Random, 95% CI)

4.14 [2.92, 5.87]

2 Difficult tracheal intubation: depolarizing vs non‐depolarizing NMBA Show forest plot

32

3413

Risk Ratio (M‐H, Random, 95% CI)

5.25 [3.61, 7.63]

2.1 Depolarizing NMBA

16

1540

Risk Ratio (M‐H, Random, 95% CI)

5.79 [2.64, 12.72]

2.2 Non‐depolarizing NMBA

16

1873

Risk Ratio (M‐H, Random, 95% CI)

4.72 [3.17, 7.02]

3 Difficult tracheal intubation: remifentanil vs no remifentanil Show forest plot

26

3008

Risk Ratio (M‐H, Random, 95% CI)

5.64 [3.82, 8.31]

3.1 Remifentanil

4

372

Risk Ratio (M‐H, Random, 95% CI)

15.86 [4.43, 56.71]

3.2 No remifentanil

22

2636

Risk Ratio (M‐H, Random, 95% CI)

5.23 [3.54, 7.74]

4 Difficult tracheal intubation: alfentanil vs no alfentanil Show forest plot

26

2618

Risk Ratio (M‐H, Random, 95% CI)

4.77 [3.25, 7.01]

4.1 Alfentanil

6

511

Risk Ratio (M‐H, Random, 95% CI)

4.46 [1.66, 11.98]

4.2 No alfentanil

20

2107

Risk Ratio (M‐H, Random, 95% CI)

5.10 [3.34, 7.79]

5 Difficult tracheal intubation: local anaesthesia vs no local anaesthesia Show forest plot

31

3184

Risk Ratio (M‐H, Random, 95% CI)

5.04 [3.48, 7.29]

5.1 Local anaesthesia

5

307

Risk Ratio (M‐H, Random, 95% CI)

1.90 [1.14, 3.18]

5.2 No local anaesthesia

26

2877

Risk Ratio (M‐H, Random, 95% CI)

6.26 [4.15, 9.44]

6 Difficult tracheal intubation: excluded anticipated DTI vs included anticipated DTI Show forest plot

34

3564

Risk Ratio (M‐H, Random, 95% CI)

5.00 [3.50, 7.16]

6.1 Exclusion of patients with anticipated difficult intubation

25

2886

Risk Ratio (M‐H, Random, 95% CI)

5.32 [3.54, 8.00]

6.2 No exclusion of patients with anticipated difficult intubation

9

678

Risk Ratio (M‐H, Random, 95% CI)

4.40 [1.71, 11.29]

7 Difficult tracheal intubation: "best‐case scenario" Show forest plot

34

2410

Risk Ratio (M‐H, Random, 95% CI)

5.99 [3.46, 10.38]

8 Difficult tracheal intubation excluding dose‐finding studies Show forest plot

16

1536

Risk Ratio (M‐H, Random, 95% CI)

3.40 [1.63, 7.10]

9 Difficult tracheal intubation: funding from pharmaceutical industry Show forest plot

34

3565

Risk Ratio (M‐H, Random, 95% CI)

5.00 [3.49, 7.15]

9.1 No funding from pharmaceutical industry

24

2550

Risk Ratio (M‐H, Random, 95% CI)

5.33 [3.16, 8.98]

9.2 Funding from pharmaceutical industry

10

1015

Risk Ratio (M‐H, Random, 95% CI)

4.10 [2.67, 6.31]

10 One or more events of upper airway discomfort or injury: low risk of bias vs high or uncertain risk of bias Show forest plot

7

844

Risk Ratio (M‐H, Random, 95% CI)

1.36 [1.08, 1.71]

10.1 Low risk of bias

1

73

Risk Ratio (M‐H, Random, 95% CI)

2.74 [1.21, 6.21]

10.2 High or uncertain risk of bias

6

771

Risk Ratio (M‐H, Random, 95% CI)

1.30 [1.08, 1.58]

11 One or more events of upper airway discomfort or injury: depolarizing vs non‐depolarizing NMBA Show forest plot

7

846

Risk Ratio (M‐H, Random, 95% CI)

1.37 [1.09, 1.74]

11.1 Depolarizing NMBA

2

180

Risk Ratio (M‐H, Random, 95% CI)

1.48 [0.83, 2.65]

11.2 Non‐depolarizing NMBA

5

666

Risk Ratio (M‐H, Random, 95% CI)

1.37 [0.97, 1.94]

12 One or more events of upper airway discomfort or injury: remifentanil vs no remifentanil Show forest plot

7

846

Risk Ratio (M‐H, Random, 95% CI)

1.37 [1.09, 1.74]

12.1 Remifentanil

2

193

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.61, 2.08]

12.2 No remifentanil

5

653

Risk Ratio (M‐H, Random, 95% CI)

1.42 [1.16, 1.75]

13 One or more events of upper airway discomfort or injury: alfentanil vs no alfentanil Show forest plot

5

446

Risk Ratio (M‐H, Random, 95% CI)

1.47 [0.85, 2.53]

13.1 No alfentanil

5

446

Risk Ratio (M‐H, Random, 95% CI)

1.47 [0.85, 2.53]

14 One or more events of upper airway discomfort or injury: excluded anticipated DTI vs included anticipated DTI Show forest plot

7

846

Risk Ratio (M‐H, Random, 95% CI)

1.37 [1.09, 1.74]

14.1 Excluded anticipated DTI

6

766

Risk Ratio (M‐H, Random, 95% CI)

1.37 [1.05, 1.79]

14.2 Included anticipated DTI

1

80

Risk Ratio (M‐H, Random, 95% CI)

2.0 [0.39, 10.31]

15 Difficult laryngoscopy: low risk of bias vs high or uncertain risk of bias Show forest plot

13

1308

Risk Ratio (M‐H, Random, 95% CI)

2.54 [1.53, 4.21]

15.1 Low risk of bias

1

78

Risk Ratio (M‐H, Random, 95% CI)

4.0 [0.47, 34.20]

15.2 High or uncertain risk of bias

12

1230

Risk Ratio (M‐H, Random, 95% CI)

2.47 [1.47, 4.16]
Figuras y tablas -
Comparison 1. Avoidance vs use of NMBA
Ir a la tabla de la revisión