Nociceptive stimulation during Macintosh direct laryngoscopy compared with McGrath Mac videolaryngoscopy: A randomized trial using indirect evaluation using an automated administration of propofol and remifentanil

Rathvirak Ing, Ngai Liu, Thierry Chazot, Julien Fessler, Jean François Dreyfus, Marc Fischler, Morgan Le Guen, Rathvirak Ing, Ngai Liu, Thierry Chazot, Julien Fessler, Jean François Dreyfus, Marc Fischler, Morgan Le Guen

Abstract

Background: Decrease of the nociceptive stimulation induced by laryngoscopy could be an advantage for patients without risk of difficult intubation. The present study aimed to compare the difference in nociceptive stimulation between the use of a conventional laryngoscope or of a videolaryngoscope. Amount of nociception was assessed indirectly using the peak remifentanil concentration determined by a closed-loop administration of propofol and remifentanil with bispectral index (BIS) as the input signal (target 50).

Methods: A prospective single-center randomized study was performed including surgical patients without predictable risk of difficult mask ventilation or of difficult tracheal intubation. Forty consecutive surgery patients were randomly assigned to CL group (conventional laryngoscope) or VL group (McGrath Mac videolaryngoscope). Induction of anesthesia was performed automatically using the closed-loop system and myorelaxation with atracurium. The allocation was revealed just before tracheal intubation. The primary outcome was the peak plasma remifentanil concentration observed during the 5-minute period which followed intubation.

Results: Sixteen patients in the CL group and 11 in the VL group were analyzed. Plasmatic remifentanil and propofol concentrations were similar in both groups either before tracheal intubation or during the 5 minutes following intubation. There was a nonsignificant between-group difference (P = .09) for the peak concentration of remifentanil. A comparable result was observed for other outcomes except for the heart rate which increased in the CL group.

Conclusion: Use of the videolaryngoscope McGrath Mac did not reduce the nociceptive stimulation induced during intubation as evaluated by the automatically administered remifentanil concentration.

Trial registration: ClinicalTrials.gov, NCT02245789.

Conflict of interest statement

The authors disclose no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow diagram. VL group: McGrath Mac videolaryngoscope group. CL group: Conventional Macintosh laryngoscope group.
Figure 2
Figure 2
BIS values (up), propofol calculated plasma concentrations (middle), remifentanil calculated plasma concentrations (bottom) before (T0) and during the 5 minutes after intubation (T1–T5). Calculated used the pharmacokinetic models of Schnider for propofol[9] and Minto for remifentanil.[10] Representation uses box plots (median, 25 and 75 percentiles, 10 and 90 percentiles). BIS = Bispectral index. T1 to T5: first to fifth minutes after intubation. Grey boxes: conventional laryngoscope. White boxes: McGrath Mac videolaryngoscopy.

References

    1. Hagberg CA, Connis RT. Difficult Airway Society 2015 guidelines for the management of unanticipated difficult intubation in adults: not just another algorithm. Br J Anaesth 2015;115:812–4.
    1. Liu N, Chazot T, Hamada S, et al. Closed-loop coadministration of propofol and remifentanil guided by bispectral index: a randomized multicenter study. Anesth Analg 2011;112:546–57.
    1. Bataille A, Besset S, Szekely B, et al. Impact of a preoperative conversational hypnotic session on propofol consumption using closed-loop anesthetic induction guided by the bispectral index: a randomized controlled trial. Medicine (Baltimore) 2017;96:e6389.
    1. Liu N, Le Guen M, Boichut N, et al. Nitrous oxide does not produce a clinically important sparing effect during closed-loop delivered propofol-remifentanil anaesthesia guided by the bispectral index: a randomized multicentre study. Br J Anaesth 2014;112:842–51.
    1. Le Guen M, Liu N, Tounou F, et al. Dexmedetomidine reduces propofol and remifentanil requirements during bispectral index-guided closed-loop anesthesia: a double-blind, placebo-controlled trial. Anesth Analg 2014;118:946–55.
    1. Dumans-Nizard V, Le Guen M, Sage E, et al. Thoracic epidural analgesia with levobupivacaine reduces remifentanil and propofol consumption evaluated by closed-loop titration guided by the bispectral index: a double-blind placebo-controlled study. Anesth Analg 2017;125:635–42.
    1. Yentis SM, Lee DJ. Evaluation of an improved scoring system for the grading of direct laryngoscopy. Anaesthesia 1998;53:1041–4.
    1. Levitan RM, Ochroch EA, Kush S, et al. Assessment of airway visualization: validation of the percentage of glottic opening (POGO) scale. Acad Emerg Med 1998;5:919–23.
    1. Schnider TW, Minto CF, Shafer SL, et al. The influence of age on propofol pharmacodynamics. Anesthesiology 1999;90:1502–16.
    1. Minto CF, Schnider TW, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil. II. Model application. Anesthesiology 1997;86:24–33.
    1. Constant I, Sabourdin N. Monitoring depth of anesthesia: from consciousness to nociception. A window on subcortical brain activity. Paediatr Anaesth 2015;25:73–82.
    1. Guignard B, Menigaux C, Dupont X, et al. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation. Anesth Analg 2000;90:161–7.
    1. Orliaguet GA, Benabbes Lambert F, Chazot T, et al. Feasibility of closed-loop titration of propofol and remifentanil guided by the bispectral monitor in pediatric and adolescent patients: a prospective randomized study. Anesthesiology 2015;122:759–67.
    1. Liu N, Lory C, Assenzo V, et al. Feasibility of closed-loop co-administration of propofol and remifentanil guided by the bispectral index in obese patients: a prospective cohort comparison. Br J Anaesth 2015;114:605–14.
    1. Liu N, Chazot T, Trillat B, et al. Closed-loop control of consciousness during lung transplantation: an observational study. J Cardiothorac Vasc Anesth 2008;22:611–5.
    1. Restoux A, Grassin-Delyle S, Liu N, et al. Pilot study of closed-loop anaesthesia for liver transplantation. Br J Anaesth 2016;117:332–40.
    1. Liu N, Pruszkowski O, Leroy JE, et al. Automatic administration of propofol and remifentanil guided by the bispectral index during rigid bronchoscopic procedures: a randomized trial. Can J Anaesth 2013;60:881–7.
    1. Nishikawa K, Matsuoka H, Saito S. Tracheal intubation with the PENTAX-AWS (airway scope) reduces changes of hemodynamic responses and bispectral index scores compared with the Macintosh laryngoscope. J Neurosurg Anesthesiol 2009;21:292–6.
    1. Koyama Y, Nishihama M, Inagawa G, et al. Comparison of haemodynamic responses to tracheal intubation using the Airway Scope((R)) and Macintosh laryngoscope in normotensive and hypertensive patients. Anaesthesia 2011;66:895–900.
    1. Carassiti M, Zanzonico R, Cecchini S, et al. Force and pressure distribution using Macintosh and GlideScope laryngoscopes in normal and difficult airways: a manikin study. Br J Anaesth 2012;108:146–51.
    1. Lee C, Russell T, Firat M, et al. Forces generated by Macintosh and GlideScope(R) laryngoscopes in four airway-training manikins. Anaesthesia 2013;68:492–6.
    1. Caldiroli D, Molteni F, Sommariva A, et al. Upper limb muscular activity and perceived workload during laryngoscopy: comparison of Glidescope(R) and Macintosh laryngoscopy in manikin: an observational study. Br J Anaesth 2014;112:563–9.
    1. Russell T, Khan S, Elman J, et al. Measurement of forces applied during Macintosh direct laryngoscopy compared with GlideScope(R) videolaryngoscopy. Anaesthesia 2012;67:626–31.
    1. Lee RA, van Zundert AA, Maassen RL, et al. Forces applied to the maxillary incisors during video-assisted intubation. Anesth Analg 2009;108:187–91.
    1. Pieters B, Maassen R, Van Eig E, et al. Indirect videolaryngoscopy using Macintosh blades in patients with non-anticipated difficult airways results in significantly lower forces exerted on teeth relative to classic direct laryngoscopy: a randomized crossover trial. Minerva Anestesiol 2015;81:846–54.
    1. Braunholtz DA, Edwards SJ, Lilford RJ. Are randomized clinical trials good for us (in the short term)? Evidence for a “trial effect”. J Clin Epidemiol 2001;54:217–24.
    1. Brogi E, Cyr S, Kazan R, et al. Clinical performance and safety of closed-loop systems: a systematic review and meta-analysis of randomized controlled trials. Anesth Analg 2017;124:446–55.
    1. Pasin L, Nardelli P, Pintaudi M, et al. Closed-loop delivery systems versus manually controlled administration of total IV anesthesia: a meta-analysis of randomized clinical trials. Anesth Analg 2017;124:456–64.
    1. Bansal VK, Hester DL. Closed-loop anesthesia: not ready for takeoff. Anesth Analg 2017;125:360–1.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel