Haemodynamic Response to Four Different Laryngoscopes (original) (raw)
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Pakistan Armed Forces Medical Journal
Objective: To compare hemodynamic changes (systolic blood pressure and pulse) after intubation with Macintosh and McCoy laryngoscopes. Study Design: Randomised control trial (Clinicaltrials.gov: NCT05133375) Place and Duration of Study: Combined Military Hospital, Jhelum Pakistan, from Apr to Oct 2021. Methodology: A group of 272 patients reporting to the operation theatre were selected and divided into Group-A and B using the lottery method. All patients had ASA class I and II score and Mallampati score of I and II with no comorbid conditions. Macintosh laryngoscope was used in Group-A, and McCoy laryngoscope was used in Group-B. Before intubation, systolic blood pressure and pulse were measured, as well as 30 seconds, 2 minutes, and 3 minutes following intubation. In addition, a comparison of both groups regarding systolic blood pressure and pulse was made. Results: The patients in the study had a mean age of 34.93±9.66 years. The increase (20%) in heart rate was significantly hig...
Comparison of hemodynamic response to tracheal intubation with Macintosh and McCoy laryngoscopes
Journal of Anaesthesiology Clinical Pharmacology, 2013
Background: Use of McCoy blade laryngoscope avoids the lifting force in the vallecula and theoretically should lead to a lower hemodynamic response related to laryngoscopy and tracheal intubation. The available literature on the topic is conflicting. Materials and Methods: We studied the hemodynamic response to laryngoscopy and tracheal intubation in 60 ASA 1 AND 2 adult patients using either Macintosh or McCoy laryngoscopes. The change in systolic, diastolic, mean arterial pressure, and heart rate (HR) was observed for 10 min post intubation. Arrhythmias and ST changes were also observed. Results: The maximum change in HR was 18.7% in the Macintosh and 7.7% in the McCoy group, and in systolic arterial pressure was 22.9% in the Macintosh and 10.3% in the McCoy group. This difference between groups was significant (P < 0.0001). The change lasted for a lesser duration in the McCoy group. No arrhythmias or ST changes were observed in either group. Conclusion: Hemodynamic changes with use of McCoy laryngoscope were lesser in magnitude and of shorter duration.
journal of medical science and clinical research, 2017
Background: Stress response to laryngoscopy and tracheal intubation have a profound influence on the circulatory parameters and the intracranial pressure. The mean increase in arterial pressure of the order of 20-25 mmHg with a maximum rise of 40-45 mmHg has been reported. This peak response occurs approximately 30-45 seconds after laryngoscopy and lasts less than ten minutes. Forces transmitted by the laryngoscope blades on the base of the tongue are assumed to be a major stimulus. Sympathoadrenal response arises from the stimulation of the supraglottic region by the laryngoscope blade. When planning the anaesthesia induction, these effects must be blunted as much as possible. Materials and Methods: This observational study was conducted at SMHS hospital of government medical college Srinagar. The study was conducted over a period of one year and total number of 100 patients were scheduled for elective procedures by randomly allocating to either Macintosh or McCoy laryngoscopy group. Aim was to Comparision of haemodynamic responses between the two groups. Comparing the time of laryngoscopy and intubation between the two groups and Comparing the laryngeal visualization grading between two groups. An informed written consent was taken from all patients at the time of pre-anaesthetic examination. Laryngoscopy and intubation was performed by standardized anesthetic technique. Size 3 laryngoscope blade was used in all cases. Monitoring include: measurement of noninvasive BP, heart rate (HR), any dysrhythmia .oxygen saturation, end-tidal carbon dioxide, concentration of inhalational anesthetic agent. All values were recorded before induction, immediately before and after laryngoscopy and tracheal intubation, every minute for 5 min following tracheal intubation, and then 10 min after intubation. Results: The baseline characteristics of the patients in terms of age, weight, height, sex distribution, Mallampati grading and the difference was not statistically significant similar between both the groups which indicated that both the groups were comparable. Maximal rise in heart rate was seen immediately post insertion with mean (107.9) in group A and mean (97.2) in group B respectively, and maximal value of standard deviation was seen after 3 min after insertion 4.34 in group A and 4.29 in group B. On comparison of blood and mean arterial pressure between two groups blood and mean arterial pressure was lower in group B with p statistically significant immediately post insertion,1 min and 3 min, and p is statistically insignificant after 5min. Conclusion: McCoy laryngoscope produces significantly less rise in hemodynamic parameters as compared to Macintosh laryngoscope during laryngoscopy and intubation.
A review of hemodynamic response to the use of different types of laryngoscopes
Endotracheal intubation is the gold standard in airway management either as a means to administer general anesthesia or for mechanical ventilation in critically ill patients for protecting the airway when the airway reflexes are dysfunctional. Macintosh laryngoscope is the standard laryngoscope used for intubation though advances in science have resulted in development of laryngoscopes of different designs. The process of laryngoscopy and intubation (L&I) can result in significant hemodynamic response and this is a topic of debate and research in anesthesia. A comprehensive review of hemodynamic responses to various laryngoscope designs has been undertaken here. Tracheal intubation contributes to more hemodynamic response compared to laryngoscopy alone. The hemodynamic responses to L&I are exaggerated in the elderly and those with uncontrolled hypertension. Orotracheal intubation causes less hemodynamic response as compared to nasotracheal intubation. Laryngoscope design, duration of L&I and the forces applied on the laryngoscope all contribute to hemodynamic fluctuations. McCoy blade and videolaryngoscopes where L&I can be performed without the aid of stylets provide better attenuation of hemodynamic response compared to intubation using the Macintosh laryngoscope. Fibreoptic orotracheal intubation with the aid of combined lingual traction and jaw thrust maneuver provides superior attenuation of hemodynamic response compared to use of laryngoscope.
IP innovative publication pvt. ltd, 2019
ntroduction and Objectives: Endotracheal intubation involving conventional laryngoscopy elicits a hemodynamic stress response which can be deleterious in susceptible individuals. The study was aimed to see if King Vision video laryngoscope has any advantages over conventional Macintosh laryngoscope in attenuating the hemodynamic response during endotracheal intubation. Materials and Methods: 80 ASA I and II patients (aged 18-59 years) who fit the eligibility criteria and scheduled for elective surgery under general anesthesia were recruited for the study after obtaining permission from the institutional review board. By randomization they were allocated into two groups. Group A underwent intubation with King Vision video laryngoscope (KVVL) and group B were intubated with Macintosh laryngoscope (MDL). Systolic BP, diastolic BP, mean arterial pressure, heart rate and Sp02 were measured at baseline, post induction, prelaryngoscopy and post intubation at 1, 3 and 5 minutes. The time duration for intubation, numbers of attempts for intubation and postoperative pharyngeal morbidities were also noted. Results: The duration of laryngoscopy and intubation was significantly longer in group A (KVVL) when compared to group B (MDL) patients (18.28 6.555 Vs. 14.75 3.678 seconds)(p = 0.004). However, patients in group A (KVVL) had less hemodynamic response compared to group B (MDL) with statistically significant heart rate changes at 3 minutes post intubation. (86.3715.255 Vs 94.4519.123 beats/minute respectively)(p = 0.040). There were no significant differences between both the groups in terms of number of attempts and post operative oropharyngeal morbidities. Conclusion: We conclude that King Vision video laryngoscope is a useful alternative to traditional Macintosh laryngoscope for reducing hemodynamic stress response during endotracheal intubation.
Academia Anesthesiologica International, 2019
Background: Aim: The aim of the present study is to assess and compare the efficacy of Macintosh laryngoscope with C-MAC video laryngoscope in attenuating the hemodynamic stress responses to laryngoscopy and endotracheal intubation. Subjects and Methods: A total of 60 patients of ASA grade I or II who were admitted in the hospital for general anaesthesia were included in the study. The total number of patients was randomly divided into two groups containing 30 patients each. In one of the group the endotracheal intubation was performed using the Macintosh laryngoscope while in the other group the endotracheal intubation was performed using the C-MAC video laryngoscope. After successful completion of the intubation process the various hemodynamic parameters were constantly recorded at regular time interval for any sign of hemodynamic response among the patients post intubation. Results: Hemodynamic parameters such as systolic, diastolic and mean arterial pressures and mean heart rate were found to be significantly higher among the Macintosh laryngoscope group in comparison to the C-MAC group. However, no significant difference was observed in the percentage of oxygen saturation among the two groups. The time taken for glottis view and total time taken for intubation was found to be significantly higher among the patients intubated with Macintosh laryngoscope in comparison to C-MAC laryngoscope. The increase in the total time taken for intubation was significantly found to increase the hemodynamic response among the patients signifying the increased risk of hemodynamic complications among patients intubated with Macintosh laryngoscope. Cormack-Lehane grading was found to be higher among the patients intubated with the Macintosh laryngoscope which might have resulted in the increased intubation time among the patients intubated with Macintosh laryngoscope. The percentage of successful intubation at the first attempt was also found to be higher in the C-MAC laryngoscope group in comparison to the Macintosh group.The percentage of glottis opening (POGO) was found to increase significantly with C-MAC video laryngoscope in comparison to the Macintosh laryngoscope. Conclusion: The study concluded that video guided C-MAC laryngoscope was a better alternative to conventional Macintosh laryngoscope with decreased hemodynamic response and increased successful intubation among the patients
Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Nasotracheal intubation is frequently used for orofacial and ENT surgeries. Greater variations occur in haemodynamics of the patient during nasotracheal intubation. So, in order to find a laryngoscope which will provide better haemodynamic stability, the present study was conducted where changes in haemodynamic parameters were compared between Truview EVO2 video laryngoscope and Macintosh laryngoscope during laryngoscopy and nasotracheal intubation. MATERIALS AND METHODS This is a randomised controlled trial. Sixty adult patients of ASA grade I and II posted for orofacial and ENT surgeries were randomly allocated into two groups depending on the type of laryngoscope used: Group 1 (n= 30)-laryngoscopy with Macintosh blade and Group 2 (n= 30)-laryngoscopy with Truview EVO2 blade. After induction with propofol and succinylcholine, laryngoscopy and nasotracheal intubation was performed according to the group. Haemodynamic variables (HR, SBP, DBP, MAP) were recorded at different time intervals upto 15 minutes duration after intubation. The data was tabulated and statistically analysed. RESULTS As compared to Macintosh laryngoscope, Truview EVO2 video laryngoscope had lesser fluctuations in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure at 1 and 5 minutes after intubation. CONCLUSION As compared to Macintosh laryngoscope, video laryngoscope provides greater haemodynamic stability during nasotracheal intubation.
Iranian Red Crescent Medical Journal, 2014
To determine if the GlideScope® videolaryngoscope (GVL) could attenuate the hemodynamic responses to orotracheal intubation compared with conventional Macintosh laryngoscope. Objectives: The aim of this relatively large randomized trial was to compare the hemodynamic stress responses during laryngoscopy and tracheal intubation using GVL versus MCL amongst healthy adult individuals receiving general anesthesia for elective surgeries. Patients and Methods: Ninety five healthy adult patients with American Society of Anesthesiologists physical status class I or II that were scheduled for elective surgery under general anesthesia were randomly allocated to either Macintosh or GlideScope arms. All patients received a standardized protocol of general anesthesia. Hemodynamic changes associated with intubation were recorded before and at 1, 3 and 5 minutes after the intubation. The time taken to perform endotracheal intubation was also noted in both groups. Results: Immediately before laryngoscopy (pre-laryngoscopy), the values of all hemodynamic variables did not differ significantly between the two groups (All P values > 0.05). Blood pressures and HR values changed significantly over time within the groups. Time to intubation was significantly longer in the GlideScope (15.9 ± 6.7 seconds) than in the Macintosh group (7.8 ± 3.7 sec) (P< 0.001). However, there were no significant differences between the two groups in hemodynamic responses at all time points. Conclusions: The longer intubation time using GVL suggests that the benefit of GVL could become apparent if the time taken for orotracheal intubation could be decreased in GlideScope group.
Global Anesthesia and Perioperative Medicine, 2015
Background: Direct laryngoscopy and intubation leads to elevated hemodynamic responses which should be attenuated by either by medication or by modifying technique by using alternative endotracheal tube guiding devices. Intubating Laryngeal Mask Airway (ILMA) can lessen the hemodynamic response of endotracheal intubation. The present study was designed to compare the hemodynamic responses during intubation by direct laryngoscopy and during ILMA. Material methods: After Ethical Committee approval, eighty adult consented patients of ASA grade I/II aged 18-60 years of either sex, undergoing elective surgeries under general anaesthesia were randomized into two groups using sealed envelopes. Patients of Group I-were intubated by using ILMA and patients of Group M were intubated by using Macintosh laryngoscope. The general anaesthesia technique was standardized. Heart rate, systolic and diastolic blood pressure and any another complications were noted at various time intervals for statistical analysis, using one way ANOVA and chi square test. P value of <0.05 was considered statistically significant. Results: Demographic profile was comparable. The mean time taken with the ILMA was 85.25 ± 13.19 seconds and was only 17.25 ± 9.74 seconds using the Macintosh laryngoscope with p=0.001. The baseline heart rate was comparable but post intubation till 5 minutes, it was statistically significant. Systolic blood pressure between Group I and Group M were also compared and the p-values were statistically highly significant after intubation at immediate post intubation. There was significant difference in rise in diastolic blood pressure between groups. No statistically significant difference between the two groups with regards to complications was observed. Conclusion: ILMA is a safer alternative to Macintosh laryngoscope as ILMA attenuated the hemodynamic stress responses to tracheal intubation and may be preferred in hypertensive patients.