TY - JOUR
T1 - Optimal dose of succinylcholine for laryngeal mask airway insertion
T2 - Systematic review, meta-analysis and metaregression of randomised control trials
AU - Liao, Alan Hsi Wen
AU - Lin, Yu Cih
AU - Bai, Chyi Huey
AU - Chen, Chien Yu
N1 - Publisher Copyright:
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Objectives To evaluate the optimal dose of succinylcholine for laryngeal mask airway (LMA) insertion and all related morbidities. Design Systematic review, meta-analysis and metaregression of randomised controlled trials (RCTs). Data source and study eligibility criteria A comprehensive search of RCTs in the PubMed, Embase, the Cochrane Library and the ClinicalTrials.gov registry up to July 2016 and articles that evaluated the use of succinylcholine chloride for LMA insertion were included in the analyses. The relative risk (RR) and the corresponding 95% CIs were determined. Intervention Succinylcholine as the coinduction agent and the doses were divided into mini (≤0.3 mg/kg) and low (0.3-1.0 mg/kg) doses for dose-dependent effect analyses. Primary and secondary outcomes The primary outcome was the first-attempt LMA insertion failure rate. Secondary outcomes included all related adverse events. Results Data from 10 RCTs comprising 625 participants showed that succinylcholine reduced the first-attempt LMA insertion failure rate (RR, 0.22; 95% CI 0.12 to 0.43), coughing and gagging (RR, 0.26; 95% CI 0.15 to 0.45) and laryngospasm (RR, 0.14; 95% CI 0.05 to 0.39). The use of succinylcholine did not result in a significant increase of postoperative myalgia (RR, 2.58; 95% CI 0.79 to 8.44) and did not reduce the risk of postoperative sore throat (RR, 0.76; 95% CI 0.55 to 1.03). Subgroup analysis further showed that low-dose succinylcholine reduced the LMA insertion failure rate and its related coughing and gagging when compared with mini dose. Conclusion The use of succinylcholine compared with none can facilitate LMA insertion and reduce insertion-related reflexes without significant postoperative myalgia. However, additional prospective studies with a larger sample size are required to fully evaluate the dose-dependent effect and complications of succinylcholine for LMA insertion.
AB - Objectives To evaluate the optimal dose of succinylcholine for laryngeal mask airway (LMA) insertion and all related morbidities. Design Systematic review, meta-analysis and metaregression of randomised controlled trials (RCTs). Data source and study eligibility criteria A comprehensive search of RCTs in the PubMed, Embase, the Cochrane Library and the ClinicalTrials.gov registry up to July 2016 and articles that evaluated the use of succinylcholine chloride for LMA insertion were included in the analyses. The relative risk (RR) and the corresponding 95% CIs were determined. Intervention Succinylcholine as the coinduction agent and the doses were divided into mini (≤0.3 mg/kg) and low (0.3-1.0 mg/kg) doses for dose-dependent effect analyses. Primary and secondary outcomes The primary outcome was the first-attempt LMA insertion failure rate. Secondary outcomes included all related adverse events. Results Data from 10 RCTs comprising 625 participants showed that succinylcholine reduced the first-attempt LMA insertion failure rate (RR, 0.22; 95% CI 0.12 to 0.43), coughing and gagging (RR, 0.26; 95% CI 0.15 to 0.45) and laryngospasm (RR, 0.14; 95% CI 0.05 to 0.39). The use of succinylcholine did not result in a significant increase of postoperative myalgia (RR, 2.58; 95% CI 0.79 to 8.44) and did not reduce the risk of postoperative sore throat (RR, 0.76; 95% CI 0.55 to 1.03). Subgroup analysis further showed that low-dose succinylcholine reduced the LMA insertion failure rate and its related coughing and gagging when compared with mini dose. Conclusion The use of succinylcholine compared with none can facilitate LMA insertion and reduce insertion-related reflexes without significant postoperative myalgia. However, additional prospective studies with a larger sample size are required to fully evaluate the dose-dependent effect and complications of succinylcholine for LMA insertion.
KW - laryngeal mask
KW - meta-analysis
KW - succinylcholine
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U2 - 10.1136/bmjopen-2016-014274
DO - 10.1136/bmjopen-2016-014274
M3 - Review article
AN - SCOPUS:85027261452
SN - 2044-6055
VL - 7
JO - BMJ Open
JF - BMJ Open
IS - 8
M1 - e014274
ER -