Hemodynamic responses to tracheal intubation with Bonfils compared to C-MAC videolaryngoscope: a randomized trial

Youssef Ezhar,Pablo Echave,Frederick D’Aragon

doi:10.1186/s12871-018-0592-7

Abstract

BackgroundDirect laryngoscopy (DL) produce tachycardia and hypertension that could be fatal in a patient with a brain injury. Bonfils fiberscope and C-MAC videolaryngoscope are associated with little hemodynamic instability compared to DL. Scientific evidence comparing these two alternatives does not exist. We conducted this study to determine the hemodynamic effects of Bonfils compared to C-MAC in patients undergoing elective surgery.MethodsFifty (50) patients listed for elective surgery were randomly assigned to endotracheal intubation with Bonfils or C-MAC. After a standardized induction, intubation was done via the retromolar approach (Bonfils group) or via videolaryngoscopy (C-MAC group). A research assistant, who was not blinded to the intervention, recorded heart rate (HR) and arterial blood pressure (systolic, diastolic and mean arterial blood pressure [MAP]) at induction and at every minute during the 5 min post intubation. The primary outcome was the hemodynamic response to intubation, as verified every minute for the first 5 min compared to baseline value.ResultsAfter randomization, the two groups were comparable except for ASA I/II ratio which was slightly higher in the C-MAC group (p = 0.046). Heart rate (p = 0.40) and MAP (p = 0.30) were comparable between the two groups within 5 min post intubation. Intubation time was shorter with C-MAC than with Bonfils (30 ± 2 s vs 38 ± 2 s; p = 0.02).ConclusionHemodynamic responses to tracheal intubation using the Bonfils fiberscope is comparable to the C-MAC videolaryngoscope among patients scheduled for an elective surgery. In light of these findings, using either technique appears to be a reasonable course of action.Trial registrationISRCTN #34923, retrospectively registered, 26/03/2018.

Highlights

Direct laryngoscopy (DL) produce tachycardia and hypertension that could be fatal in a patient with a brain injury
This study evaluates the effect on heart rate and blood pressure of healthy patients undergoing tracheal intubation using Bonfils or C-MAC
In summary, our study demonstrated that the hemodynamic responses to endotracheal intubation with Bonfils fiberscope is comparable to the C-MAC videolaryngoscope in ASA 1 and 2 patients

Summary

Introduction

Direct laryngoscopy (DL) produce tachycardia and hypertension that could be fatal in a patient with a brain injury. Bonfils fiberscope and C-MAC videolaryngoscope are associated with little hemodynamic instability compared to DL. We conducted this study to determine the hemodynamic effects of Bonfils compared to C-MAC in patients undergoing elective surgery. Direct laryngoscopy can produce marked hemodynamic responses, such as tachycardia and hypertension. This response may be induced by direct contact of the blade with the posterior third of the tongue and the effect of raising the richly innervated epiglottis [1, 2]. As described by Schribman, the insertion of the endotracheal tube between the vocal cords is responsible for catecholamine release [2] This study evaluates the effect on heart rate and blood pressure of healthy patients undergoing tracheal intubation using Bonfils or C-MAC

Methods

Results

Conclusion