INTRODUCTION
The benefit of using neuromuscular blocking agents to facilitate tracheal intubation in
children remains unclear, owing to variations in design and outcomes between trials. By
combining the available evidence and investigating reasons for between-study heterogeneity, we aimed to establish whether scientific findings are consistent and can be generalized across populations, settings and treatment variations.
METHODS
A systematic search for randomised and controlled clinical trials related to the use of
neuromuscular blockers for tracheal intubation in children (1-12 y) was performed. We
explored heterogeneity using both pair-wise meta-analysis on subgroups and meta-regression analysis on relaxant groups. This allowed us to identify characteristics associated with variation between study outcomes. For indirect and mixed comparisons, we used network meta-analysis to compare different interventions, even when, for some pairs of treatments, no trials of head-to-head comparisons exist. Network meta-analysis was performed using multivariate random-effect meta-regression models while odds ratios were used to calculate a hierarchy of alternative treatments.
RESULTS/CONCLUSION
We included 63 eligible trials of 4934 participants. The use of neuromuscular blockers was found to improve both, haemodynamic stability and quality of intubation. Intubation
conditions depended upon the choice and dose of the relaxant, patients' age, the use of
propofol and the context of an elective or rapid sequence induction. Although opioids can
have a major influence on the quality of intubation, no such association could be
demonstrated when using rocuronium or suxamethonium to facilitate airway insertion.
Network meta-analysis allowed to interpret the wider picture of evidence and to estimate the relative merits of different interventions.

06 / Systematic review with network meta-analysis of neuromuscular blocking agents to facilitate endotracheal intubation in children aged 1-12 years.