Neuromuscular Block and Video Laryngoscope to Facilitate Intubation-A Survey of Current Practice in Denmark and Sweden.

Abstract

Background: Neuromuscular blocking agents (NMBA) provide optimal conditions for tracheal intubation. A high dose of opioid can be used as an alternative but may give suboptimal conditions for intubation. The use of a video laryngoscope for intubation might eliminate this potential difference.

Methods: A survey examining clinical practice regarding tracheal intubation with and without NMBA and use of video laryngoscopes was conducted in Sweden and Denmark.

Results: 1771 out of 3181 (56%) of invited anaesthetists responded. Overall, 1365/1771 (77%) preferred using NMBAs for non-acute tracheal intubation with a considerably higher NMBA preference in Sweden 1011/1073 (94%) than in Denmark 354/700 (51%). A high proportion of Danish anaesthetists 327/700 (47%) compared to 40/1071 (4%) of Swedish anaesthetists reported primarily using opioids without NMBA. Remifentanil was the preferred opioid (1158/1361 (85%)) for intubation without NMBA. The reasons for using NMBA were improved intubating conditions (948/1771 (54%)), departmental tradition (285/1771 (16%)), adherence to local guidelines (264/1771 (15%)), and adherence to national/international guidelines (143/1771 (8%)). Video laryngoscopes were present in every operating theatre for 349/700 (50%) of Danish anaesthetists and 131/1071 (12%) of Swedish anaesthetists. Video laryngoscopes were easily accessible outside the operating room for 350/700 (50%) of Danish anaesthetists and 940/1071 (88%) of Swedish anaesthetists.

Conclusions: NMBA use remains the standard for non-acute tracheal intubation. However, a substantial number of anaesthetists regularly employ a NMBA-free approach facilitated by high-potency opioids and video laryngoscopy, particularly in Denmark. These findings emphasise the need for further research and subsequently updated evidence-based guidance to support safe and effective intubation practices.

Editorial comment: This study, reporting a survey of anesthesia practitioners in Sweden and Denmark assessed preferences concerning how the respondents would manage a series of case scenarios concerning anesthetic drug choices for facilitation of intubation and employment of video laryngoscopy. Quite a bit of variation for preferences is presented by the responses concerning neuromuscular blockade or not to facilitate intubation.