Use of the GlideScope does not lower the hemodynamic response to tracheal intubation more than the Macintosh laryngoscope: a systematic review and meta-analysis

Hiroshi Hoshijima, Koichi Maruyama, Takahiro Mihara, Aiji Sato Boku, Toshiya Shiga, Hiroshi Nagasaka, Hiroshi Hoshijima, Koichi Maruyama, Takahiro Mihara, Aiji Sato Boku, Toshiya Shiga, Hiroshi Nagasaka

Abstract

Background: It is presently unclear whether the hemodynamic response to intubation is less marked with indirect laryngoscopy using the GlideScope (GlideScope) than with direct laryngoscopy using the Macintosh laryngoscope. Thus, the aim of this study was to determine whether using the GlideScope lowers the hemodynamic response to tracheal intubation more than using the Macintosh laryngoscope.

Methods: We performed a comprehensive literature search of electronic databases for clinical trials comparing hemodynamic response to tracheal intubation. The primary aim was to determine whether the heart rate (HR) and mean blood pressure (MBP) 60 s after tracheal intubation with the GlideScope were lower than after intubation with the Macintosh laryngoscope. We expressed pooled differences in HR and MBP between the devices as the weighted mean difference with 95% confidence interval and also performed trial sequential analysis (TSA). Second, we examined whether use of the GlideScope resulted in lower post-intubation hemodynamic responses at 120, 180, and 300 s compared with use of the Macintosh laryngoscope. For sensitivity analysis, we used a multivariate random effects model that accounted for within-study correlation of the longitudinal data.

Results: The literature search identified 13 articles. HR and MBP at 60 seconds post-intubation was not significantly lower with the GlideScope than with the Macintosh (HR vs MBP: weighted mean difference = 0.22 vs 2.56; 95% confidence interval -3.43 to 3.88 vs -0.82 to 5.93; P = .90 vs 0.14; I = 77% vs 63%: Cochran Q, 52.7 vs 27.2). Use of the GlideScope was not associated with a significantly lower HR or MBP at 120, 180, or 300 s post-intubation. TSA indicated that the total sample size was over the futility boundary for HR and MBP. Sensitivity analysis indicated no significant association between use of the GlideScope and a lower HR or MBP at any measurement point.

Conclusions: Compared with the Macintosh laryngoscope, the GlideScope did not lower the hemodynamic response after tracheal intubation. Sensitivity analysis results supported this finding, and the results of TSA suggest that the total sample size exceeded the TSA monitoring boundary for HR and MBP.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Meta-analysis flow chart. RCT = randomized controlled trial.
Figure 2
Figure 2
Forest plot of heart rate for tracheal intubation using the GlideScope compared with the Macintosh laryngoscope.
Figure 3
Figure 3
Forest plot of mean blood pressure for tracheal intubation using the GlideScope compared with the Macintosh laryngoscope.
Figure 4
Figure 4
The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Figure 5
Figure 5
Green circles, red circles, and yellow circles indicate “low risk of bias,” “high risk of bias,” and “unclear risk of bias,” respectively.

References

    1. Takki S, Tammisto T, Nikki P, et al. Effect of laryngoscopy and intubation on plasma catecholamine levels during intravenous induction of anaesthesia. Br J Anaesth 1972;44:1323–8.
    1. Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987;59:295–9.
    1. Forbes AM, Dally FG. Acute hypertension during induction of anaesthesia and endotracheal intubation in normotensive man. Br J Anaesth 1970;42:618–24.
    1. Bullington J, Mouton Perry SM, Rigby J, et al. The effect of advancing age on the sympathetic response to laryngoscopy and tracheal intubation. Anesth Analg 1989;68:603–8.
    1. Tomori Z, Widdicombe JG. Muscular, bronchomotor and cardiovascular reflexes elicited by mechanical stimulation of the respiratory tract. J Physiol 1969;200:25–49.
    1. Sun HL, Wu TJ, Ng CC, et al. Efficacy of oropharyngeal lidocaine instillation on hemodynamic responses to orotracheal intubation. J Clin Anesth 2009;21:103–7.
    1. Edwards ND, Alford AM, Dobson PM, et al. Myocardial ischaemia during tracheal intubation and extubation. Br J Anaesth 1994;73:537–9.
    1. Prys-Roberts C, Greene LT, Meloche R, et al. Studies of anaesthesia in relation to hypertension. II. Haemodynamic consequences of induction and endotracheal intubation. Br J Anaesth 1971;43:531–47.
    1. Sun DA, Warriner CB, Parsons DG, et al. The glidescope video laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth 2005;94:381–4.
    1. Ahmad N, Zahoor A, Riad W, et al. Influence of GlideScope assisted endotracheal intubation on intraocular pressure in ophthalmic patients. Saudi J Anaesth 2015;9:195–8.
    1. Griesdale DE, Liu D, McKinney J, et al. Glidescope(R) video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis. Can J Anaesth 2012;59:41–52.
    1. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med 2009;3:e123–130.
    1. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011. Available from: .
    1. Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490.
    1. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ 2003;327:557–60.
    1. Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softw 2010;36:1–48.
    1. Wetterslev J, Thorlund K, Brok J, et al. Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis. J Clin Epidemiol 2008;61:64–75.
    1. Thorlund K, Engstrøm J, Wetterslev J, Brok J, Imberger G, C G. User manual for trial sequential analysis (TSA). 2011. Available from: . Accessed 12 January, 2016.
    1. Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–34.
    1. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088–101.
    1. Amini S, Shakib M. Hemodynamic changes following endotracheal intubation in patients undergoing cesarean section with general anesthesia: application of glidescope(R) videolaryngoscope versus direct laryngoscope. Anesth Pain Med 2015;5:e21836.
    1. Ke J, Xu Q. Comparison the applications of tracheal intubation with GlideScope video laryngoscope and Macintosh direct laryngoscope in snoring patients. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2013;27:468–70.
    1. Malik MA, Maharaj CH, Harte BH, et al. Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization. Br J Anaesth 2008;101:723–30.
    1. Malik MA, Subramaniam R, Maharaj CH, et al. Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation. Br J Anaesth 2009;103:761–8.
    1. Parasa M, Yallapragada SV, Vemuri NN, et al. Comparison of GlideScope video laryngoscope with Macintosh laryngoscope in adult patients undergoing elective surgical procedures. Anesth Essays Res 2016;10:245–9.
    1. Pournajafian AR, Ghodraty MR, Faiz SH, et al. Comparing glidescope video laryngoscope and macintosh laryngoscope regarding hemodynamic responses during orotracheal intubation: a randomized controlled trial. Iran Red Crescent Med J 2014;16:e12334.
    1. Siddiqui N, Katznelson R, Friedman Z. Heart rate/blood pressure response and airway morbidity following tracheal intubation with direct laryngoscopy, GlideScope and Trachlight: a randomized control trial. Eur J Anaesthesiol 2009;26:740–5.
    1. Xue FS, Li XY, Liu QJ, et al. Circulatory responses to nasotracheal intubation: comparison of GlideScope videolaryngoscope and Macintosh direct laryngoscope. Chin Med J (Engl) 2008;121:1290–6.
    1. Xue FS, Zhang GH, Li XY, et al. Comparison of hemodynamic responses to orotracheal intubation with the GlideScope videolaryngoscope and the Macintosh direct laryngoscope. J Clin Anesth 2007;19:245–50.
    1. Li XY, Xue FS, Sun L, et al. [Comparison of hemodynamic responses to nasotracheal intubations with Glide Scope video-laryngoscope, Macintosh direct laryngoscope, and fiberoptic bronchoscope]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2007;29:117–23.
    1. Bilehjani E, Solmaz F. Hemodynamic response to laryngoscopy in ischemic heart disease: macintosh blade versus glidescope® videolaryngoscope. Rawal Med J 2009;34:1–6.
    1. Dashti M, Amini S, Azarfarin R, et al. Hemodynamic changes following endotracheal intubation with glidescope((R)) video-laryngoscope in patients with untreated hypertension. Res Cardiovasc Med 2014;3:e17598.
    1. Hindman BJ, Santoni BG, Puttlitz CM, et al. Intubation biomechanics: laryngoscope force and cervical spine motion during intubation with Macintosh and Airtraq laryngoscopes. Anesthesiology 2014;121:260–71.
    1. Goto T, Koyama Y, Kondo T, et al. A comparison of the force applied on oral structures during intubation attempts between the Pentax-AWS airwayscope and the Macintosh laryngoscope: a high-fidelity simulator-based study. BMJ Open 2014;4:e006416.
    1. Evans A, Vaughan RS, Hall JE, et al. A comparison of the forces exerted during laryngoscopy using disposable and non-disposable laryngoscope blades. Anaesthesia 2003;58:869–73.
    1. Bucx MJ, Scheck PA, Van Geel RT, et al. Measurement of forces during laryngoscopy. Anaesthesia 1992;47:348–51.
    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. Teoh WH, Shah MK, Sia AT. Randomised comparison of Pentax AirwayScope and Glidescope for tracheal intubation in patients with normal airway anatomy. Anaesthesia 2009;64:1125–9.
    1. Hoshijima H, Maruyama K, Mihara T, et al. Airtraq(R) reduces the hemodynamic response to tracheal intubation using single-lumen tubes in adults compared with the Macintosh laryngoscope: A systematic review and meta-analysis of randomized control trials. J Clin Anesth 2018;47:86–94.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅