{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T19:03:41Z","timestamp":1772478221572,"version":"3.50.1"},"reference-count":28,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T00:00:00Z","timestamp":1714435200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005111","name":"Rigshospitalet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005111","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The European Society of Anesthesiology and Intensive Care recommends the use of neuromuscular blocking agents (NMBA) in adults, to facilitate tracheal intubation and reduce its associated complications. Children who undergo tracheal intubation may suffer some of the same complications, however, no consensus exists regarding the use of NMBA for tracheal intubation in the pediatric population.<\/jats:p><jats:p>We will explore the existing evidence assessing the effects of avoidance versus the use of NMBA for the facilitation of tracheal intubation in children and infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This protocol follows the preferred reporting items for systematic reviews and meta\u2010analyses protocols recommendations. We will include all randomized controlled clinical trials assessing the effects of avoidance versus the use of NMBA for facilitation of tracheal intubation (oral or nasal) using direct laryngoscopy or video laryngoscopy in pediatric participants (&lt;18\u2009years). Our primary outcome is incidence of difficult tracheal intubation. Secondary outcomes include incidence of serious adverse events, failed intubation, events of upper airway discomfort or injury, and difficult laryngoscopy.<\/jats:p><jats:p>We will conduct a thorough database search to identify relevant trials, including CENTRAL, MEDLINE, EMBASE, BIOSIS, Web of Science, CINAHL, and trial registries. Two review authors will independently handle the screening of literature and data extraction. Each trial will be evaluated for major sources of bias with the \u201cclassic risk of bias tool\u201d used in the Cochrane Collaboration tool from 2011. We will use Review manager (RevMan) or R with the meta package to perform the meta\u2010analysis. We will perform a trial sequential analysis on the meta\u2010analysis of our primary outcome, providing an estimate of statistical reliability.<\/jats:p><jats:p>Two review authors will independently assess the quality of the body of evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. We will use GRADEpro software to conduct the GRADE assessments and to create \u201cSummary of the findings\u201d tables.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.14429","type":"journal-article","created":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T09:28:21Z","timestamp":1714469301000},"page":"1094-1100","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Effects of avoidance versus use of neuromuscular blocking agents for facilitation of tracheal intubation in children and infants: a protocol for a systematic review, meta\u2010analysis and trial sequential analysis"],"prefix":"10.1111","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1940-2590","authenticated-orcid":false,"given":"Michelle Icka","family":"Christensen","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Operation and Trauma Center, Centre of Head and Orthopedics, Copenhagen University Hospital\u2013Rigshospitalet  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matias","family":"Vested","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Operation and Trauma Center, Centre of Head and Orthopedics, Copenhagen University Hospital\u2013Rigshospitalet  Copenhagen Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Creutzburg","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Operation and Trauma Center, Centre of Head and Orthopedics, Copenhagen University Hospital\u2013Rigshospitalet  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anders Kehlet","family":"N\u00f8rskov","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Copenhagen University Hospital\u2013Nordsj\u00e6llands Hospital  Hiller\u00f8d Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2179-1433","authenticated-orcid":false,"given":"Lars Hyldborg","family":"Lundstr\u00f8m","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Anesthesiology Copenhagen University Hospital\u2013Nordsj\u00e6llands Hospital  Hiller\u00f8d Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arash","family":"Afshari","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Anesthesiology and Operation Juliane Marie Center, Copenhagen University Hospital\u2013Rigshospitalet  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,4,30]]},"reference":[{"key":"e_1_2_18_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer058"},{"key":"e_1_2_18_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199912000-00023"},{"key":"e_1_2_18_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200305000-00005"},{"key":"e_1_2_18_5_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-6576.2001.450109.x"},{"key":"e_1_2_18_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2010.03284.x"},{"key":"e_1_2_18_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0b013e3283532ac4"},{"key":"e_1_2_18_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000000608"},{"key":"e_1_2_18_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(15)00508-1"},{"key":"e_1_2_18_10_1","first-page":"1086","article-title":"Difficult tracheal intubation in neonates and infants. 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