Paediatric anaesthesia & critical care
Effects of avoidance versus use of neuromuscular blocking agents for facilitation of tracheal intubation in children and infants: A systematic review with meta-analysis and trial sequential analysis
Pooled resultResult — go to the resultRelative risk 3.47 95% CI 2.52–4.77Authors' conclusion
Using NMBAs for facilitation of tracheal intubation reduces the incidence of difficult tracheal intubation compared to avoidance of NMBA in children and infants.
Study context
- Population
- Paediatric patients undergoing tracheal intubation (oral or nasal) by direct or video laryngoscopy for any procedure requiring GA
- Participants
- 2,276 patients · 47 RCTs
- Comparison
- Avoidance vs use of NMBA for facilitation of tracheal intubation
- Outcome
- Incidence of difficult tracheal intubation
Methodological detailstrial sequential analysis, 3 trials at low risk of bias
- Trial sequential analysis
- 3 trials at low risk of bias
Pooled result
As reported in the abstract
Relative risk
3.47
95% CI 2.52–4.77
P < 0.001
Avoidance of NMBAs vs Use of NMBA
RR 3.47 (95% CI 2.52–4.77); P < 0.001
Further pooled results
Difficult tracheal intubation (trial sequential analysis)
- α-spending adjusted RR when avoiding neuromuscular blocking agents (NMBAs)
- 3.68 (95% CI, 2.22 to 6.11; α = 5%, β = 90%)
- Trial sequential analysis
Safety
Serious adverse events
- No significant increased risk with avoidance vs use of NMBA
- Very low certainty of evidence
Original publication
Effects of avoidance versus use of neuromuscular blocking agents for facilitation of tracheal intubation in children and infants: A systematic review with meta-analysis and trial sequential analysis. Eur J Anaesthesiol. Published 2 February 2026. doi:10.
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