Article of the Month, May 2023

Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration. A Randomized Clinical Trial.

Grillot, N et al., JAMA. 2023;329(1):28-38. doi:10.1001/jama.2022.23550

with Erratum: JAMA. 2023 Feb 14;329(6):515. doi: 10.1001/jama.2023.0424.

This is a multicenter, randomized, open-label, noninferiority trial with 1150 adults at risk of aspiration undergoing tracheal intubation in the operating room at 15 hospitals in France. Patients received neuromuscular blockers (1 mg/kg of succinylcholine or rocuronium; n = 575) or remifentanil (3 to 4 μg/kg; n = 575) immediately after injection of a hypnotic.

Reminfentanil was found to be inferior to neuromuscular blockers with regards to the primary outcome successful tracheal intubation on the first attempt without major complications.

This is an interesting study to discuss the concept of non-inferiority designs and the implications of assumptions in the design of such studies.

Enjoy the read!

BW, Maren