Original Article Hemodynamic changes during orotracheal intubation using Airtraq video laryngoscope and direct laryngoscope: A randomized comparative study
DOI:
https://doi.org/10.3126/jsan.v6i1.24299Keywords:
Airtraq, endotracheal intubation, hemodynamic changes, intubation time, video laryngoscopyAbstract
Introduction: Direct laryngoscopy is associated with sympathetic stimulation and altered hemodynamics. A long intubation time may result in a greater in stress response. Alternative techniques using video laryngoscopes have been developed that do not require direct vocal cord visualization and may decrease the hemodynamic response. This study aimed to compare the difference between hemodynamic changes and intubation time with Airtraq video laryngoscope and conventionl Macintosh direct laryngoscope.
Methods: A prospective randomized comparative study was conducted involving 100 adult patients who were undergoing elective surgeries under general anesthesia and endotracheal intubation. The patients were randomly assigned to group V (Video laryngoscope) or group D (Direct laryngoscope). In addition to the baseline vitals and vitals at various time intervals, intubation time was also recorded. We considered a difference in Heart Rate and Mean Arterial pressure of 20% to be clinically significant and statistical significance was p-value <0.05.
Results: Significant difference was found in heart rates immediately after laryngoscopy (110.40 vs. 105.02 beats/minute; p<0.01) and 1 minute after intubation (109.30 vs. 106.20 beats/minute; p<0.01) with attenuation seen in video laryngoscopy group. Blood pressures were similar in both the groups at all times. Time for intubation was prolonged in video laryngoscopy group than that for direct laryngoscopy group (26.54 vs. 22.80 seconds; p<0.05). There were no adverse events associated with either of the techniques.
Conclusions: The Airtraq video laryngoscopy resulted in lesser change in heart rate and longer intubation time. However, clinical impact of such a difference seemed to be insignificant.
References
Forbes AM, Dally FG. Acute hypertension during induction of anaesthesia and endotracheal intubation in normotensive man. BJA: British Journal of Anaesthesia. 1970 Jul 1;42(7):618-24. https://doi.org/10.1093/bja/42.7.618 PMid:5453244
Yoo KY, Lee J, Kim HS, Im WM. Hemodynamic and catecholamine responses to laryngoscopy and tracheal intubation in patients with complete spinal cord injuries. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2001 Sep 1;95(3):647-51. https://doi.org/10.1097/00000542-200109000-00017 PMid:11575537
Kanchi M, Nair HC, Banakal S, Murthy K, Murugesan C. Haemodynamic response to endotracheal intubation in coronary artery disease: Direct versus video laryngoscopy. Indian journal of anaesthesia. 2011 May;55(3):260. https://doi.org/10.4103/0019-5049.82673 PMid:21808398 PMCid:PMC3141150
Das B, Samal RK, Ghosh A, Kundu R. A randomised comparative study of the effect of Airtraq optical laryngoscope vs. Macintosh laryngoscope on intraocular pressure in non-ophthalmic surgery. Brazilian Journal of Anesthesiology (English Edition). 2016 Jan 1;66(1):19-23. https://doi.org/10.1016/j.bjane.2014.07.004 PMid:26768925
Ke J, Xu Q. Comparison the applications of tracheal intubation with GlideScope video laryngoscope and Macintosh direct laryngoscope in snoring patients. Journal of clinical otorhinolaryngology, head, and neck surgery. 2013 May;27(9):468-70.
Pournajafian AR, Ghodraty MR, Faiz SH, Rahimzadeh P, Goodarzynejad H, Dogmehchi E. Comparing GlideScope video laryngoscope and Macintosh laryngoscope regarding hemodynamic responses during orotracheal intubation: A randomized controlled trial. Iranian Red Crescent Medical Journal. 2014 Apr;16(4):e12334. https://doi.org/10.5812/ircmj.12334 PMid:24910788 PMCid:PMC4028761
Hirabayashi Y, Hiruta M, Kawakami T, Inoue S, Fukuda H, Saitoh K, et al. Effects of lightwand (Trachlight) compared with direct laryngoscopy on circulatory responses to tracheal intubation. British journal of anaesthesia. 1998 Aug 1;81(2):253-5. https://doi.org/10.1093/bja/81.2.253 PMid:9813535
Monte FR, Giraldo JC, Betancur LA, Rincón JD, Rincón IE, Vanegas MV, et al. Endotracheal intubation with a lightwand or a laryngoscope results in similar hemodynamic variations in patients with coronary artery disease. Canadian Journal of Anesthesia. 2003 Oct 1;50(8):824. https://doi.org/10.1007/BF03019380
Ing R, Liu N, Chazot T, Fessler J, Dreyfus JF, Fischler M, et al. Nociceptive stimulation during Macintosh direct laryngoscopy compared with McGrath Mac videolaryngoscopy: A randomized trial using indirect evaluation using an automated administration of propofol and remifentanil. Medicine (Baltimore). 2017 Sep;96(38):e8087. https://doi.org/10.1097/MD.0000000000008087 PMid:28930848 PMCid:PMC5617715
Castillo-Monzon CG, Marroquin-Valz HA, Fernandez-Villacanas-Marin M, Moreno-Cascales M, Garcia-Rojo B, Candia-Arana CA. Comparison of the macintosh and airtraq laryngoscopes in morbidly obese patients: a randomized and prospective study. Journal of clinical anesthesia. 2017 Feb 1;36:136-41. https://doi.org/10.1016/j.jclinane.2016.10.023 PMid:28183552
Misirlioglu G, Sen O. Comparison of GlideScope video laryngoscopy and Macintosh laryngoscope in ear–nose and throat surgery. Irish Journal of Medical Science. 2016 Aug 1;185(3):729-33. https://doi.org/10.1007/s11845-015-1393-3 PMid:26732694
Maharaj CH, O'croinin D, Curley G, Harte BH, Laffey JG. A comparison of tracheal intubation using the Airtraq or the Macintosh laryngoscope in routine airway management: a randomised, controlled clinical trial. Anaesthesia. 2006 Nov;61(11):1093-9. https://doi.org/10.1111/j.1365-2044.2006.04819.x PMid:17042849
Jafra A, Gombar S, Kapoor D, Sandhu HS, Kumari K. A prospective randomized controlled study to evaluate and compare GlideScope with Macintosh laryngoscope for ease of endotracheal intubation in adult patients undergoing elective surgery under general anesthesia. Saudi journal of anaesthesia. 2018 Apr;12(2):272. https://doi.org/10.4103/sja.SJA_543_17 PMid:29628839 PMCid:PMC5875217
Maassen RL, Pieters BM, Maathuis B, Serroyen J, Marcus MA, Wouters P, van Zundert AA. Endotracheal intubation using videolaryngoscopy causes less cardiovascular response compared to classic direct laryngoscopy, in cardiac patients according a standard hospital protocol. Acta Anaesthesiol Belg. 2012 Jan 1;63(4):181-6.
Dashti M, Amini S, Azarfarin R, Totonchi Z, Hatami M. Hemodynamic changes following endotracheal intubation with glidescope® video-laryngoscope in patients with untreated hypertension. Research in cardiovascular medicine. 2014 May;3(2):e17598. https://doi.org/10.5812/cardiovascmed.17598 PMid:25478537 PMCid:PMC4253794
Yu JH, Wang Y. Clinical study of SMT-â…¡ video laryngoscope with difficult airway intubation in emergency department. Zhonghua wai ke za zhi [Chinese journal of surgery]. 2017 Jul;55(7):549-53.
Parasa M, Yallapragada SV, Vemuri NN, Shaik MS. Comparison of GlideScope video laryngoscope with Macintosh laryngoscope in adult patients undergoing elective surgical procedures. Anesthesia, essays and researches. 2016 May;10(2):245. https://doi.org/10.4103/0259-1162.167840 PMid:27212755 PMCid:PMC4864696
Choi GS, Lee EH, Lim CS, Yoon SH. A comparative study on the usefulness of the Glidescope or Macintosh laryngoscope when intubating normal airways. Korean journal of anesthesiology. 2011 May;60(5):339. https://doi.org/10.4097/kjae.2011.60.5.339 PMid:21716906 PMCid:PMC3110292
Erdivanli B, Sen A, Batcik S, Koyuncu T, Kazdal H. Comparison of King Vision video laryngoscope and Macintosh laryngoscope: a prospective randomized controlled clinical trial. Brazilian Journal of Anesthesiology (English Edition). 2018 Sep 1;68(5):499-506. https://doi.org/10.1016/j.bjane.2018.04.008
Dhonneur G, Abdi W, Ndoko SK, Amathieu R, Risk N, El Housseini L, Polliand C, et al. Video-assisted versus conventional tracheal intubation in morbidly obese patients. Obesity surgery. 2009 Aug 1;19(8):1096-101. https://doi.org/10.1007/s11695-008-9719-0 PMid:18836785
Bajwa SJ, Kaur J, Singh A, Parmar SS, Singh G, Kulshrestha A, Gupta S, Sharma V, Panda A. Attenuation of pressor response and dose sparing of opioids and anaesthetics with pre-operative dexmedetomidine. Indian journal of anaesthesia. 2012 Mar;56(2):123-8. https://doi.org/10.4103/0019-5049.96303 PMid:22701201 PMCid:PMC3371485
Downloads
Published
How to Cite
Issue
Section
License
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
