Hemodynamic changes following endotracheal intubation with glidescope(®) video-laryngoscope in patients with untreated hypertension

Majid Dashti, Shahram Amini, Rasoul Azarfarin, Ziae Totonchi, Maryam Hatami, Majid Dashti, Shahram Amini, Rasoul Azarfarin, Ziae Totonchi, Maryam Hatami

Abstract

Background: Tracheal intubation can be associated with considerable hemodynamic changes, particularly in patients with uncontrolled hypertension. The GlideScope(®) video-laryngoscope (GVL) is a novel video laryngoscope that does not need direct exposure of the vocal cords, and it can also produce lower hemodynamic changes due to lower degrees of trauma and stimuli to the oropharynx than a Macintosh direct laryngoscope (MDL).

Objectives: The aim of this clinical trial was to compare hemodynamic alterations following tracheal intubation with a GVL and MDL in patients with uncontrolled hypertension.

Patients and methods: Sixty patients who had uncontrolled hypertension and scheduled for elective surgery requiring tracheal intubation, were randomly assigned to receive intubated with either a GVL (n = 30) or a MDL (n = 30). Intubation time, heart rate, rate pressure product (RPP), and mean arterial blood pressure (MAP), were compared between the two groups at; baseline, following induction of anesthesia, after intubation, and at one minute intervals for 5 minutes.

Results: A total of 59 patients finished the study. Intubation time was longer in the GVL group (9.80 ± 1.27 s) than in the MDL group (8.20 ± 1.17 s) (P < 0.05). MAP, pulse rate, and RPP were lower in the GVL than the MDL group after endotracheal intubation (P < 0.05). MAP, heart rate, and RPP returned to pre-intubation values at 3 and 4 minutes after intubation in the GVL and MDL groups, respectively (P < 0.05).

Conclusions: Hemodynamic fluctuations in patients with uncontrolled hypertension after endotracheal intubation were lower with the GVL than the MDL technique.

Keywords: Airway Management; Hemodynamics; Hypertension; Intubation, Intratracheal; Laryngoscopes.

Figures

Figure 1.. Systolic, Mean and Diastolic arterial…
Figure 1.. Systolic, Mean and Diastolic arterial Pressure Values During the Study in Both Groups (1 = GVL and 2 = MDL)
GVL, GlideScope® video-laryngoscope; MDL, Macintosh direct laryngoscope.
Figure 2.. Heart Rate Values During the…
Figure 2.. Heart Rate Values During the Study in Both Groups (1 = GVL and 2 = MDL)
GlideScope® video-laryngoscope; MDL, Macintosh direct laryngoscope.
Figure 3.. RPR values during the study…
Figure 3.. RPR values during the study in both groups (1 = GVL and 2 = MDL)
GVL, GlideScope® video-laryngoscope; MDL, Macintosh direct laryngoscope.

References

    1. Golzari SE, Khan ZH, Ghabili K, Hosseinzadeh H, Soleimanpour H, Azarfarin R, et al. Contributions of Medieval Islamic physicians to the history of tracheostomy. Anesth Analg. 2013;116(5):1123–32. doi: 10.1213/ANE.0b013e3182884313.
    1. Soleimanpour H, Gholipouri C, Panahi JR, Afhami MR, Ghafouri RR, Golzari SE, et al. Role of anesthesiology curriculum in improving bag-mask ventilation and intubation success rates of emergency medicine residents: a prospective descriptive study. BMC Emerg Med. 2011;11:8. doi: 10.1186/1471-227X-11-8.
    1. Beyer K, Taffe P, Halfon P, Pittet V, Pichard S, Haller G, et al. Hypertension and intra-operative incidents: a multicentre study of 125,000 surgical procedures in Swiss hospitals. Anaesthesia. 2009;64(5):494–502. doi: 10.1111/j.1365-2044.2008.05821.x.
    1. Goldman L, Caldera DL. Risks of general anesthesia and elective operation in the hypertensive patient. Anesthesiology. 1979;50(4):285–92.
    1. Helfman SM, Gold MI, DeLisser EA, Herrington CA. Which drug prevents tachycardia and hypertension associated with tracheal intubation: lidocaine, fentanyl, or esmolol? Anesth Analg. 1991;72(4):482–6.
    1. Omote K, Kirita A, Namiki A, Iwasaki H. Effects of nicardipine on the circulatory responses to tracheal intubation in normotensive and hypertensive patients. Anaesthesia. 1992;47(1):24–7.
    1. Huang WT, Huang CY, Chung YT. Clinical comparisons between GlideScope video laryngoscope and Trachlight in simulated cervical spine instability. J Clin Anesth. 2007;19(2):110–4. doi: 10.1016/j.jclinane.2006.06.004.
    1. Malik MA, Maharaj CH, Harte BH, Laffey JG. Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization. Br J Anaesth. 2008;101(5):723–30. doi: 10.1093/bja/aen231.
    1. Xue FS, Zhang GH, Liu J, Li XY, Yang QY, Xu YC, et al. The clinical assessment of Glidescope in orotracheal intubation under general anesthesia. Minerva Anestesiol. 2007;73(9):451–7.
    1. Xue FS, Xu YC, Liu QJ, Yang QY, Liu Y, Liao X, et al. Hemodynamic responses to tracheal intubation with the Glidescope videolaryngoscope: a comparison of oral and nasal routes. Acta Anaesthesiol Taiwan. 2008;46(1):8–15.
    1. Zhang GH, Xue FS, Li CW, Sun HY, Li XY, Sun HT, et al. [Comparison of hemodynamic responses to orotracheal intubation between using GlideScope videolaryngoscope and fiberoptic bronchoscope]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2006;28(3):406–9.
    1. Xue FS, Zhang GH, Li XY, Sun HT, Li P, Sun HY, et al. Comparison of haemodynamic responses to orotracheal intubation with GlideScope videolaryngoscope and fibreoptic bronchoscope. Eur J Anaesthesiol. 2006;23(6):522–6. doi: 10.1017/S0265021506000299.
    1. Xue FS, Zhang GH, Li XY, Sun HT, Li P, Li CW, et al. Comparison of hemodynamic responses to orotracheal intubation with the GlideScope videolaryngoscope and the Macintosh direct laryngoscope. J Clin Anesth. 2007;19(4):245–50. doi: 10.1016/j.jclinane.2006.11.004.
    1. Howell SJ, Sear JW, Foex P. Hypertension, hypertensive heart disease and perioperative cardiac risk. Br J Anaesth. 2004;92(4):570–83. doi: 10.1093/bja/aeh091.
    1. Prys-Roberts C, Meloche R, Foex P. Studies of anaesthesia in relation to hypertension. I. Cardiovascular responses of treated and untreated patients. Br J Anaesth. 1971;43(2):122–37.
    1. Mangano DT, Browner WS, Hollenberg M, London MJ, Tubau JF, Tateo IM. Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group. N Engl J Med. 1990;323(26):1781–8. doi: 10.1056/NEJM199012273232601.
    1. Pasternack PF, Grossi EA, Baumann FG, Riles TS, Lamparello PJ, Giangola G, et al. Beta blockade to decrease silent myocardial ischemia during peripheral vascular surgery. Am J Surg. 1989;158(2):113–6.
    1. Weksler N, Klein M, Szendro G, Rozentsveig V, Schily M, Brill S, et al. The dilemma of immediate preoperative hypertension: to treat and operate, or to postpone surgery? J Clin Anesth. 2003;15(3):179–83.
    1. Aghdaii N, Azarfarin R, Yazdanian F, Faritus SZ. Cardiovascular responses to orotracheal intubation in patients undergoing coronary artery bypass grafting surgery. Comparing fiberoptic bronchoscopy with direct laryngoscopy. Middle East J Anesthesiol. 2010;20(6):833–8.
    1. Ziyaeifard M, Azarfarin R, Massoumi G. A comparison of intraocular pressure and hemodynamic responses to insertion of laryngeal mask airway or endotracheal tube using anesthesia with propofol and remifentanil in cataract surgery. J Res Med Sci. 2012;17(6):503–7.
    1. Gobel FL, Norstrom LA, Nelson RR, Jorgensen CR, Wang Y. The rate-pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris. Circulation. 1978;57(3):549–56.
    1. Xue FS, Li XY, Liu QJ, Liu HP, Yang QY, Xu YC, et al. Circulatory responses to nasotracheal intubation: comparison of GlideScope videolaryngoscope and Macintosh direct laryngoscope. Chin Med J (Engl). 2008;121(14):1290–6.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit