Comparative Evaluation of Lightwand (Lighted Stylet) with Direct Laryngoscopy on Hemodynamic Response- A Prospective Study

Subham Garg

doi:10.4172/2155-6148.1000419

Abstract

Background:Laryngoscopy and tracheal intubation are often associated with hypertension, tachycardia, and an increase in plasma catecholamine concentrations. The present study was done to compare the hemodynamic response during tracheal intubation, guided by either Lightwand or Direct laryngoscopy. Method and patients: Seventy adult consented patients of ASA I or II aged 18-58 years of either sex scheduled for elective surgeries from September 2011 to March 2013 were randomized according to sealed envelopes into two groups of 35 patients each. The patients of Group LWI were intubated with lighted stylet (Lightwand, GE) and patients of Group DLI were intubated using direct laryngoscope (Macintosh). Any patient with history of systemic hypertension and cardiopulmonary disease, hepatic, renal or endocrine disorder, difficult airway or MP Grade III & IV, history of previous difficult tracheal intubation or patient who required more than 30 seconds or more than one attempt for intubation were excluded. The anesthetic induction technique was standardized. The hemodynamic parameters of heart rate, blood pressure and ECG were recorded, at baseline, after induction, after tracheal intubation and then at regular interval of 1 min for 5 min after tracheal intubation. Intubation time was noted by stopwatch. Results: There was no significant difference in demographic profile, in terms of changes in blood pressure and heart rate during laryngoscopy and after tracheal intubation between groups. Post intubation dysphasia, hoarseness, sore throat were also comparable between the groups. Conclusion: The effects of Lightwand technique on hemodynamic response to tracheal intubation were similar to those of direct laryngoscopy.

Highlights

Discovery of endotracheal intubation has made administration and maintenance of anesthesia easy
Endotracheal intubation by direct laryngoscopy is frequently associated with hypertension, tachycardia, and an increase in plasma catecholamine concentrations
The present study has compared the hemodynamic changes during orotracheal intubation with direct laryngoscopy to lighted stylet technique on 70 adult normotensive patients

Summary

Introduction

Discovery of endotracheal intubation has made administration and maintenance of anesthesia easy. Endotracheal intubation by direct laryngoscopy is frequently associated with hypertension, tachycardia, and an increase in plasma catecholamine concentrations. The presser response to tracheal intubation is severe when duration of direct laryngoscopy is prolonged due to reflex sympathetic discharge and can be attenuated by beta adrenergic receptor blockade drugs or using alternative endotracheal tube guiding devices such as fiberoptic scope, light wand or laryngeal mask airway. We predicted that light wand intubation technique would cause less hemodynamic changes as than direct laryngoscopy. Laryngoscopy and tracheal intubation are often associated with hypertension, tachycardia, and an increase in plasma catecholamine concentrations. The present study was done to compare the hemodynamic response during tracheal intubation, guided by either Lightwand or Direct laryngoscopy

Methods

Results

Conclusion