A study of stress response to endotracheal intubation comparing glidescope and flexible fiberoptic bronchoscope.

Mansoor Aqil

doi:10.12669/pjms.305.4788

Abstract

Objective: To compare hemodynamic stress response (HDSR) to ET intubation using Glidescope (GLS) and Flexible fiberoptic laryngoscope (FFB). Methods: This prospective randomized comparative study was conducted at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia from June 2011 - November 2013. Eighty ASA 1 & 2 patients with normal airway undergoing elective surgical procedure requiring ET intubation were included in the study. Patients were randomly assigned in two groups GLS or FFB. General anesthesia was induced with propofol and fentanyl. Muscle relaxation was achieved with cisatracurium and ET intubation was performed using either GLS or FFB. Noninvasive hemodynamic data was recorded (HR, systolic, diastolic and mean blood pressure) as pre-induction, baseline and after ET intubation at one minute intervals for successive five minutes. End tidal Sevoflurane and CO2 at the time of intubation, need of external neck pressure, time to successful intubation and number of attempts were recorded; and rate pressure product was calculated. Results: Induction of anesthesia resulted in significant fall in blood pressure in both the groups. ET intubation resulted in similar rise of BP in both groups (for 3-4 minutes) from their baseline values; however the rise was not significantly different from their respective pre-induction values. Time to intubation was longer with FFB compared to GLS however, need for external neck manipulation was more with GLS. Conclusion: There was no difference in HDSR due to ET intubation using either GLS or FFB in healthy adult patients with normal airway. Rate pressure product remained within the acceptable range.

Highlights

Manipulation of the airway during endotracheal (ET) intubation leads to stimulation of pharyngeal and tracheolaryngeal nociceptors resulting in hemodynamic stress response (HDSR),[1] which1
There was no significant difference between the groups in age, sex, weight, height, Body mass index (BMI), preinduction HR, SBP, DBP, MAP, number of attempts for successful intubation, lowest SPO2 during intubation, end tidal CO2 at the time of intubation, end tidal SEV at the time of intubation and other airway parameters(Table-I)
Time to successful intubation was more in flexible fiberoptic bronchoscope (FFB) group while need for external manipulation of neck was more in GLS group (Table-I)

Summary

Introduction

Manipulation of the airway during endotracheal (ET) intubation leads to stimulation of pharyngeal and tracheolaryngeal nociceptors resulting in hemodynamic stress response (HDSR),[1] which. Correspondence: December 24, 2013 May 22, 2014 May 30, 2014 can be deleterious in patients with poor cardiac reserves[2] or having other comorbidities.[3] The magnitude of the HDSR is variable and proportional to the amount of force applied during visualization of the glottis[4] and the degree of tracheolaryngeal manipulation during advancement of ET into the trachea.[5]. There is some equipment available for ET intubation in which indirect laryngoscopy is used and application of upward and forward force is not required during visualization of the glottis and requires variable degree of airway manipulation during advancement of the ET tube.[6,7,8,9] Glidescope (GLS) and flexible fiberoptic bronchoscope (FFB) are two novel instruments, requiring minimum to no force during visualization of the glottis and provide an improved view.[10]

Methods

Results

Conclusion