Tracheal intubation for cesarean section without muscle relaxant: An alternative for rapid tracheal intubation with no adverse neonatal effect

Background
Difficult tracheal intubation following induction of general anaesthesia for caesarean section is a cause of morbidity and mortality. Till today, succinyl choline is the relaxant of first choice for endo-tracheal intubation However, its use is associated with marked muscle fasciculations and intense muscle pains on the day after the operation especially in young patients. Tracheal intubation may be accomplished without a muscle relaxant. In this study, we evaluated in double-blinded, prospective, randomized intubation conditions for cesarean section with fentanyl without muscle relaxant administration to obtain clinically acceptable intubation conditions and cardiovascular responses.
Methods
After the gaining of ethical approval, 100 parturients scheduled for elective cesarean delivery were randomly allocated to receive both fentanyl 2 μg/kg and propofol 2 mg/kg in group F, propofol 2 mg/kg and succinyl choline 1 mg/kg in group S. Tracheal intubation was graded by the anesthesiologist performing the intubation who was blinded to induction agents.
Results
Overall intubating conditions were regarded as acceptable in 90%, and 94% of patients in groups F and S, respectively. Apgar score and blood gases of babies were not different between two groups.
Conclusion
The results suggested that healthy pre-medicated women with favorable airway anatomy who are scheduled for cesarean section can be reliably trachealy intubated 90 s after co-administration of fentanyl 2 μg/kg and propofol 2 mg/kg with satisfactory fetal outcome.