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Tracheal intubation with and without muscular relaxation

Baillard, C.*; Samama, C. M.*

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European Journal of Anaesthesiology: April 2006 - Volume 23 - Issue 4 - p 355-356
doi: 10.1017/S0265021506250580



We thank Dr Mencke and colleagues for their comments. Their comments about the methodological limits of our observational study are true but yet clearly reported in our article and it would seem that Dr Mencke and colleagues have not read the discussion section carefully enough [1]. Also, Dr Mencke and colleagues worry about the consequences of the implementation of our results into clinical practice. In contrast, as described in their study, they had apparently no problem with intubating the trachea when the laryngoscopic conditions were clinically unacceptable (i.e. the vocal cords closed or closing) [2]. Such a protocol and the related laryngeal consequence are not representative of clinical practice. It must also be remembered that the use of muscle relaxants may be associated with anaphylactic reactions with potentially life-threatening consequences and also residual curarisation and its related postoperative pulmonary complications [34].

Our hypothesis is that the controversy should not rest on the question of whether or not muscle relaxants should be routinely employed, but rather, proponents on both sides should endeavour to identify patient groups in whom the safety of intubation may be optimized by a conscious choice of sedation and muscular relaxation.


1. Baillard C, Adnet F, Borron SW et al. Tracheal intubation in routine practice with and without muscular relaxation: an observational study. Eur J Anaesthesiol 2005; 22: 672–677.
2. Mencke T, Echternach M, Kleinschmidt S et al. Laryngeal morbidity and quality of tracheal intubation. A randomized controlled trial. Anesthesiology 2003; 98: 1049–1056.
3. Mertes PM, Laxenaire MC, Alla F, Groupe d’Etudes des Reactions Anaphylactoides Peranesthesiques. Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999–2000. Anesthesiology 2003; 99: 536–545.
4. Berg H, Roed J, Viby-Mogensen J et al. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesth Scand 1997; 41: 1095–1103.
© 2006 European Society of Anaesthesiology