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GENERAL ARTICLES

Hemodynamic Responses Among Three Tracheal Intubation Devices in Normotensive and Hypertensive Patients

Department of Anaesthesia, Pain Clinic, and Clinical Toxicology, Mito Saiseikai General Hospital, Ibaraki, Japan

Address correspondence and reprint requests to J. Brimacombe, MD, University of Queensland and James Cook University, Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. Address e-mail to jbrimacombe{at}austarnet.com.au

We compare hemodynamic responses in normotensive and hypertensive anesthetized paralyzed patients among three intubation devices: the Macintosh laryngoscope (LS), the Trachlight^TM lightwand (LW), and the intubating laryngeal mask airway Fastrach^TM (ILM). Seventy-five normotensive and 75 hypertensive patients were randomly assigned to each intubation device (n = 25). Noninvasive systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were recorded immediately preinduction, immediately preintubation, and every minute for the first 5 min after the successful intubation. The number of intubation attempts, the time to successful intubation, and any airway injuries were recorded. Pharyngolaryngeal morbidity was assessed 18–24 h after surgery by a blinded investigator. In all groups, there was a reduction in SBP and DBP but no change in HR immediately preintubation compared with baseline values. In all groups, HR increased, but there were no increases in SBP and DBP other than in DBP in the LS/hypertensive group after intubation compared with baseline values. In normotensive patients, there were no differences in any hemodynamic variables among the three devices. In hypertensive patients, SBP and DBP in the LS group were significantly higher than the ILM and LW groups for 2 min after intubation, but there were no differences in HR among the devices. The number of intubation attempts was similar among groups, but intubation time was longer for the ILM group. The incidence of airway injury was more frequent for the ILM than the LS and LW groups (16% versus 0% versus 0%). There were no differences in pharyngolaryngeal morbidity among groups. We conclude that both the ILM and the LW attenuated the hemodynamic stress response to tracheal intubation compared with the LS in hypertensive, but not in normotensive, anesthetized paralyzed patients.

IMPLICATIONS: Both the intubating laryngeal mask airway Fastrach^TM and the Trachlight^TM lightwand attenuate the hemodynamic stress response to tracheal intubation compared with the Macintosh laryngoscope in hypertensive, but not in normotensive, anesthetized paralyzed patients.

This article has been cited by other articles:

				S. Christian and M. Manji Indications for endotracheal intubation and ventilation Trauma, October 1, 2004; 6(4): 249 - 254. [Abstract] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999