Pediatric anesthesia & critical care
Effect of neuromuscular blocking agents on tracheal intubation quality in paediatric patients: a systematic review using network meta-analysis and meta-regression
Authors' conclusion
We present a meta-analytical approach to synthesise and consolidate evidence from previous research and demonstrate how neuromuscular blocking agent type and dose, intubation timing, age, and induction drugs affect the safety and efficacy of paediatric airway management.
Study context
- Population
- Healthy paediatric participants (0–12 yr) undergoing tracheal intubation under direct laryngoscopy
- Participants
- 8,008 participants · 105 trials
- Comparison
- Various NMBA types and doses vs NMBA-free tracheal intubation under direct laryngoscopy
- Outcome
- Excellent and acceptable intubation conditions (odds ratios (ORs)); MAP and HR (mean differences)
Methodological detailsBayesian network meta-analysis, pairwise and cumulative meta-analyses, meta-regression
- Bayesian network meta-analysis
- Pairwise and cumulative meta-analyses
- Meta-regression
Pooled result
As reported in the abstract
Intubation conditions
- Suxamethonium ≥1.50 mg kg-1 and rocuronium ≥0.90 mg kg-1 provided similar intubation conditions, though not consistently within 60 s
- Other neuromuscular blocking agents (NMBAs), on average, slower and less effective
- Intubation without NMBAs most difficult in neonates and infants, conditions improving until about age 4 yr; beyond this, benefit of NMBAs increased with age
Further pooled results
| Outcome | OR (95% CrI) | |
|---|---|---|
| Non-depolarising NMBAs in younger (1.64 [1.08-2.20] yr) vs older (5.53 [4.04-7.01] yr) children (meta-regression)Younger children vs Older children · excellent intubation conditions; CrI | 2.97 (1.82–5.10) | |
| Non-depolarising NMBAs in younger (1.64 [1.08-2.20] yr) vs older (5.53 [4.04-7.01] yr) children (meta-regression)Younger children vs Older children · acceptable intubation conditions; CrI | 2.29 (1.14–4.39) | |
| 0.20.5125Odds ratio (log scale) |
- Non-depolarising NMBAs in younger (1.64 [1.08-2.20] yr) vs older (5.53 [4.04-7.01] yr) children (meta-regression): Values are mean (95% credible interval)
Opioids combined with suxamethonium ≥1.00 mg kg-1 or rocuronium ≥0.90 mg kg-1
- Opioids decreased MAP and HR but did not improve intubation conditions
Original publication
Effect of neuromuscular blocking agents on tracheal intubation quality in paediatric patients: a systematic review using network meta-analysis and meta-regression. Br J Anaesth. Published 10 October 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →