Friday November 6, 2009
On Use of NMB for the emergent tracheal intubation

Use of NMB is not routinely needed for the emergent tracheal intubation of inpatients who have received adjunct sedation. Emergent inpatient tracheal intubations, in which NMB had been utilized, were associated with a greater number of intubation attempts. The use of NMB, in only a subset of inpatients, may have been due to such issues as agitation, movement, or jaw clenching. These may have happened even with seemingly adequate levels of sedation. The observed association of NMB, with a greater number of tracheal intubation attempts, may actually have represented the failure to have successfully intubated with the use of sedation alone.

Clinicians need to be aware that the routine use of NMB may not be indicated for emergent tracheal intubations of inpatients who have received sedation. Although uncommon, the use of NMB may lead to catastrophic situations in which the patient can neither be intubated nor ventilated by mask. Additionally, breath sounds, transmitted via the tracheal tube during intubation, are lost with the use of NMB. Therefore, the advantages of intubating a spontaneously breathing patient are readily evident.

There is tremendous potential for hypoxia-related complications from the use of NMB. Consideration should be given to initially attempt those emergent inpatient tracheal intubations, which require sedation, without NMB. This is especially true in situations where additional trained personnel and airway management equipment are not readily available.

Intubation of Inpatients: A Retrospective Practice Analysis Comparing Adjunct Sedation With or Without Neuromuscular Blockade . The Internet Journal of Anesthesiology. 2003 Volume 7 Number 2