Comparison of propofol-remifentanil target-controlled infusion with lidocaine versus neuromuscular blockade for laryngoscopy.

BACKGROUND

To assess the preliminary efficacy and safety of neuromuscular blocking agent (NMBA)-free anesthesia compared with standard NMBA-based protocols during tracheal intubation and postoperative recovery in patients undergoing elective suspension laryngoscopy for vocal cord polypectomy.

METHODS

In this single-center pilot randomized controlled trial, 43 patients classified as American Society of Anesthesiologists physical status I-II were randomized to receive either intravenous cisatracurium (NMBA group, N.=23) or topical 2% lidocaine (NMBA-free group, N.=20). A standardized propofol-remifentanil target-controlled infusion was administered to both groups. Surgeon satisfaction with intubation conditions was evaluated as the primary outcome, while extubation time, hemodynamic stability, and perioperative complications were recorded as secondary outcomes.

RESULTS

The NMBA-free group demonstrated comparable intubation conditions (satisfaction: 100% vs. 95.7%, P=0.31) and faster recovery profiles than the NMBA group. Specifically, extubation time was reduced by 39% (15.1±3.82 vs. 24.87±9.04 minutes; 95% CI, -13.99 to -5.55 minutes; P<0.001), and time to post-anesthesia care unit discharge decreased by 27% (33.35±7.20 vs. 45.57±13.10 minutes; 95% CI, -18.66 to -5.78 minutes; P<0.001). No laryngospasm or major complications occurred. The NMBA-free approach also provided better hemodynamic stability, as indicated by differences in mean arterial pressure (P=0.012), peripheral oxygen saturation (P=0.048), and heart rate variability (P=0.004).

CONCLUSIONS

This exploratory trial provides preliminary evidence that propofol-remifentanil TCI combined with topical lidocaine enables safe NMBA-free anesthesia for brief suspension laryngoscopy, with recovery outcomes consistent with enhanced recovery after surgery principles.