Hemodynamic changes during endotracheal intubation: A prospective randomised comparative study using fibreoptic bronchoscope and intubating laryngeal mask airway

Authors

  • Manzil Shrestha Neuro Cardio and Multi-Speciality Hospital Pvt. Ltd Biratnagar-13, Morang
  • Tanvir R Rahman BP Koirala Institute of Health Sciences, Dharan, Sunsari
  • Bikash Agarwal BP Koirala Institute of Health Sciences, Dharan, Sunsari

Keywords:

Endotracheal Intubations, Fibreoptic endoscope, haemodynamics, Laryngeal Mask Airways

Abstract

Background: Fibreoptic intubation and Intubating laryngeal mask airway are alternatives to conventional laryngoscopy. The objective of the study was to compare hemodynamic changes with the use of these two devices for tracheal intubation.

Methods: It was a randomized, comparative and prospective study of two groups comprising of 50 patients each. Tracheal intubations were performed using intubating fiberscope in group I and intubating laryngeal mask airway in Group II. Intubation time, heart rate, blood pressure and complications were compared.

Results: Heart rate response to tracheal intubation was comparable between the groups. Changes in mean arterial pressure were also comparable and returned to baseline after two minutes of tracheal intubation. The first attempt success rate was 80% and 92% respectively in Group I and Group II. The time taken for intubation was found to be significantly longer in Group II irrespective of the number of attempts. There were no major complications observed. However there was some desaturation at the time of intubation which was seen in three patients in Group I, and one patient in Group II. However the Spo2 did not fall below 96% and was not considered to be clinically significant.

Conclusions: Endotracheal intubation using either an Intubating Laryngeal Mask Airway or a Fibreoptic Bronchoscope is comparable in terms of the haemodynamic responses.

Author Biographies

Manzil Shrestha, Neuro Cardio and Multi-Speciality Hospital Pvt. Ltd Biratnagar-13, Morang

Consultant Anesthesiologist

Tanvir R Rahman, BP Koirala Institute of Health Sciences, Dharan, Sunsari

Department of Anaesthesiology and Intensive Care Medicine

Bikash Agarwal, BP Koirala Institute of Health Sciences, Dharan, Sunsari

Department of Anaesthesiology and Intensive Care Medicine

References

1. Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987;59:295-9.
2. Barak M, Ziser A, Greenberg A, Lischinsky S, Rosenberg B. Hemodynamic and catecholamine response to tracheal intubation. J Clin Anesth 2003;15:132-6.
3. Braude N, Clements EAF, Hodges UM, Andrews BP. The pressor response and laryngeal mask insertion. A comparison with tracheal intubation. Anaesthesia 1989;44:551-4.
4. Kihara S, Watanabe S, Taguchi N, Suga A. A Comparison of blind and light wand- guided tracheal intubation using the intubating laryngeal mask. Anaesthesia 2000;55:427-31.
5. King BD, Harris LC, Greifenstein FE, Elder JD, Dripps RD. Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anaesthesia. Anesthesiology 1951;12:556-66.
6. Ghai B, Sharma A, Akhtar S. Comparative evaluation of Intraocular pressure changes subsequent to insertion of Laryngeal Mask Airway and Endotracheal Tube. J Postgrad Med 2001;47:181-4.
7. Fox EJ, Sklar GS, Hill CH, Villanueva R, King BD. Complications related to the pressor response to endotracheal intubation. Anesthesiology 1977;47:524-5.
8. Burstein CL, Lo Pinto FJ, Newman W. Electrocardiographic studies during endotracheal intubation: effects during usual routine techniques. Anesthesiology 1950;11:224-37.
9. Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987;59:295-9.
10. Stoelting RK. Circulatory changes during direct laryngoscopy and tracheal intubation: Influence of duration of laryngoscopy with or without prior lidocaine. Anesthesiology 1977;47:381-3.
11. Kirhara S, Wantabe S, Taguchi N, Sugas A, Brimacombe JR. Tracheal Intubation with the Macintosh laryngoscope versus Intubating Laryngeal Mask Airway in Adults with normal airways. Anaesth Intensive Care 2000;28:281-6.
12. Brain AIJ, Verghese C, Addy EV, Kapali A, Brimacombe J. The Intubating Laryngeal Mask: preliminary clinical report of a new means of intubating the trachea. Br J Anaesth 1997;79:704-9.
13. Baskett PJ, Parr MJ, Nolan JP. The intubating laryngeal mask: Results of a multicentre trial with experience of 500 cases. Anaesthesia 1998,53:1174-9.
14. Xue FS, Li CW, Sun HT, Liu KP, Zhang GH, Xu YC , et al. The circulatory responses to fibreoptic intubation: a comparison of oral and nasal routes. Anaesthesia 2006;61:639-45.
15. Singh M. Stress response and anaesthesia altering the peri and post operative management. Indian J Anaesth 2003;47:427-34.
16. Nandi PR, Charlesworth CH, Taylor SJ, Nunn JF, Dore CJ. Effect of general anaesthesia on the pharynx. Br J Anaesth 1991;66:157-62.
17. Walls RM, Murphy MF, Luten RC, Schneider RE. Manual of emergency airway management, 2nd edn : Lippincott : Williams and Wilkins, 2004:45.
18. Takenaka I, Aoyama K, Nagaoka E, Seto A, Niijima K, Kadoya T. Malposition of epiglottis after tracheal intubation via the Intubating Laryngeal Mask. Br J Anaesth 1999;54:166-7.

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Published

2014-09-08

How to Cite

Shrestha, M., Rahman, T. R., & Agarwal, B. (2014). Hemodynamic changes during endotracheal intubation: A prospective randomised comparative study using fibreoptic bronchoscope and intubating laryngeal mask airway. Journal of Society of Anesthesiologists of Nepal, 1(2), 70-75. Retrieved from http://www.jsan.org.np/jsan/index.php/jsan/article/view/8

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