Effects of different nasotracheal intubations in obstructive sleep apnea hypopnea syndrome patients with uvulopalatopharyngoplasty

Abstract

To explore the safe and effective way of nasotracheal intubations in obstructive sleep apnea hypopnea syndrome patients with uvulopalatopharyngoplasty. Upon the approval of the Ethics Committee at Second Affiliated Hospital of Fujian Medical University, from August 2008 to November 2011, 90 sleep apnea hypopnea syndrome patients were randomly divided into 3 groups (n=30 each): GlideScope (G), fiberoptic bronchoscope (F) and combination of Glidescope with fiberoptic bronchoscope (G+F). The parameters of tracheal intubation time, placement of endotracheal intubation, tracheal injury and complications were recorded. Also systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR) were recorded at post-induction, the moment of tracheal intubation and post-intubation 1, 3, 5 min. Rate pressure product (RPP) was calculated at all time points as the product of heart rate and SBP during observation. All of them underwent successful endotracheal intubation. There were 24 successful cases of intubation during the first attempt in Group G with a success rate of 80%; 27 patients successful during the first attempt in group F with a success rate of 90%; all in group G+F successful during the first attempt with a success rate of 100%. The rates were significantly different in 3 groups (P<0.05). Groups G and F patients with failed intubation during the first attempt were of Mallampati III/IV. After induction, SBP, DBP, MAP and RPP were lower in 3 groups (P<0.05) while HR change was not obvious. Compared with the after induction, the moment of tracheal intubation and after intubation 1 min, 3 groups of patients with SBP, DBP, MAP, HR and RPP increased (P<0.05). Groups F and G+F after intubation in intubated patients and 1 min of SBP, DBP, MAP, HR, RPP were higher than G group (P<0.05). No difference existed between groups F and G+F. Three groups showed no serious tracheal injury, laryngeal edema, hoarseness or other complications. During nasotracheal intubation for Mallampati I/II patients, GlideScope offers better overall glottic views. For those of Mallampati III and IV, the combination of Glidescope with fiberoptic bronchoscope may achieve a higher success rate and shorter intubation time than the latter alone.