# Neuromuscular Block and Video Laryngoscope to Facilitate Intubation—A Survey of Current Practice in Denmark and Sweden

## TL;DR

This study surveyed Danish and Swedish anesthetists about their preferences for using neuromuscular blocking agents and video laryngoscopes during intubation, finding significant differences in practice between the two countries.

## Contribution

The study highlights regional variations in the use of neuromuscular blocking agents and video laryngoscopes for intubation, emphasizing the need for updated evidence-based guidelines.

## Key findings

- Swedish anesthetists show a much higher preference for neuromuscular blocking agents compared to Danish anesthetists.
- A significant number of Danish anesthetists use high-dose opioids without neuromuscular blocking agents, facilitated by video laryngoscopes.
- Video laryngoscopes are more accessible outside operating rooms in Denmark than in Sweden.

## Abstract

Neuromuscular blocking agents (NMBA) provide optimal conditions for tracheal intubation. A high dose of opioid can be used as an alternative but may give suboptimal conditions for intubation. The use of a video laryngoscope for intubation might eliminate this potential difference.

A survey examining clinical practice regarding tracheal intubation with and without NMBA and use of video laryngoscopes was conducted in Sweden and Denmark.

1771 out of 3181 (56%) of invited anaesthetists responded. Overall, 1365/1771 (77%) preferred using NMBAs for non‐acute tracheal intubation with a considerably higher NMBA preference in Sweden 1011/1073 (94%) than in Denmark 354/700 (51%). A high proportion of Danish anaesthetists 327/700 (47%) compared to 40/1071 (4%) of Swedish anaesthetists reported primarily using opioids without NMBA. Remifentanil was the preferred opioid (1158/1361 (85%)) for intubation without NMBA. The reasons for using NMBA were improved intubating conditions (948/1771 (54%)), departmental tradition (285/1771 (16%)), adherence to local guidelines (264/1771 (15%)), and adherence to national/international guidelines (143/1771 (8%)). Video laryngoscopes were present in every operating theatre for 349/700 (50%) of Danish anaesthetists and 131/1071 (12%) of Swedish anaesthetists. Video laryngoscopes were easily accessible outside the operating room for 350/700 (50%) of Danish anaesthetists and 940/1071 (88%) of Swedish anaesthetists.

NMBA use remains the standard for non‐acute tracheal intubation. However, a substantial number of anaesthetists regularly employ a NMBA‐free approach facilitated by high‐potency opioids and video laryngoscopy, particularly in Denmark. These findings emphasise the need for further research and subsequently updated evidence‐based guidance to support safe and effective intubation practices.

This study, reporting a survey of anesthesia practitioners in Sweden and Denmark assessed preferences concerning how the respondents would manage a series of case scenarios concerning anesthetic drug choices for facilitation of intubation and employment of video laryngoscopy. Quite a bit of variation for preferences is presented by the responses concerning neuromuscular blockade or not to facilitate intubation.