Comparison of propofol-remifentanil target-controlled infusion with lidocaine versus neuromuscular blockade for laryngoscopy

BACKGROUND: To assess the preliminary efficacy and safety of neuromuscular blocking agent (NMBA)-free anesthesia compared with standard NMBA-based protocols during tracheal intubation and postoperative recovery in patients undergoing elective suspension laryngoscopy for vocal cord polypectomy. METHODS: In this single-center pilot randomized controlled trial, 43 patients classified as American Society of Anesthesiologists physical status I-II were randomized to receive either intravenous cisatracurium (NMBA group, N.=23) or topical 2% lidocaine (NMBA-free group, N.=20). A standardized propofol-remifentanil target-controlled infusion was administered to both groups. Surgeon satisfaction with intubation conditions was evaluated as the primary outcome, while extubation time, hemodynamic stability, and perioperative complications were recorded as secondary outcomes. RESULTS: The NMBA-free group demonstrated comparable intubation conditions (satisfaction: 100% vs. 95.7%, P=0.31) and faster recovery profiles than the NMBA group. Specifically, extubation time was reduced by 39% (15.1±3.82 vs. 24.87±9.04 minutes; 95% CI, -13.99 to -5.55 minutes; P