Scientific Session III - Dysphagia and Airway Management
ALA027 - Randomized Controlled Trial Comparing General Anesthesia with Paralysis to Remifentanil and Propofol in Direct Laryngoscopy
Friday, April 29, 2022
8:24 AM – 8:30 AM CT
Location: Landmark D
Methods: This is an ongoing IRB-approved prospective, observational, single-blinded randomized controlled trial at a tertiary care center. Patients are randomized to either anesthesia regimen by alternating assignments. Patients and surgeons are blinded to the anesthetic regimen. Intraoperative impressions, anesthesia data, and post-operative patient surveys are collected. Results:
Medical Student NYU Grossman School of Medicine New York, New York
Objective: To compare surgical and patient outcomes between two standard-of-care anesthesia regimens for direct laryngoscopy (DL): general anesthesia with paralysis vs. remifentanil and propofol (non-paralysis).
Methods: This is an ongoing IRB-approved prospective, observational, single-blinded randomized controlled trial at a tertiary care center. Patients are randomized to either anesthesia regimen by alternating assignments. Patients and surgeons are blinded to the anesthetic regimen. Intraoperative impressions, anesthesia data, and post-operative patient surveys are collected.
Results: Twenty-eight patients who underwent DLs from 2020-2021 were enrolled (13 female, 15 male; average 47.5 years). Thirteen patients were enrolled in the paralysis arm, and 15 patients were enrolled in the non-paralysis arm. There were no significant patient differences between the two arms. On a scale of “good,” “fair,” or “poor”, surgeons were more likely to rate conditions for laryngoscopy as “good” in the paralysis group (77%, vs. 60% in non-paralysis), despite more instances of difficult anatomy in the paralysis group. Procedures were more likely to be paused due to movement in the non-paralysis group (n=5, vs. n=1). There were no major anesthesia-related complications with either regimen. Patients in the non-paralysis group were more likely to have pain and reported higher average pain levels on a 0-10 pain scale (3) compared to the paralysis group ( <1). The non-paralysis group required longer recovery before returning to activities of daily living (1.6 days, vs. 0.5 days).
Conclusions: In this single-blinded trial, anesthesia with paralysis during direct laryngoscopy was associated with more favorable surgical conditions and patient recovery compared to anesthesia with propofol and remifentanil.