Optimal dose of succinylcholine for laryngeal mask airway insertion: Systematic review, meta-analysis and metaregression of randomised control trials

Alan Hsi Wen Liao, Yu Cih Lin, Chyi Huey Bai, Chien Yu Chen

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere014274
JournalBMJ Open
Volume7
Issue number8
DOIs
Publication statusPublished - Aug 1 2017

Fingerprint

Laryngeal Masks
Succinylcholine
Meta-Analysis
Gagging
Randomized Controlled Trials
Myalgia
Laryngismus
Pharyngitis
Information Storage and Retrieval
PubMed
Sample Size
Libraries
Reflex
Registries
Prospective Studies
Morbidity

Keywords

  • laryngeal mask
  • meta-analysis
  • succinylcholine

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Optimal dose of succinylcholine for laryngeal mask airway insertion : Systematic review, meta-analysis and metaregression of randomised control trials. / Liao, Alan Hsi Wen; Lin, Yu Cih; Bai, Chyi Huey; Chen, Chien Yu.

In: BMJ Open, Vol. 7, No. 8, e014274, 01.08.2017.

Research output: Contribution to journalReview article

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title = "Optimal dose of succinylcholine for laryngeal mask airway insertion: Systematic review, meta-analysis and metaregression of randomised control trials",
abstract = "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.",
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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.

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