Comparison of hemodynamic responses to laryngoscopy and intubation with Truview PCD™, McGrath® and Macintosh laryngoscope in patients undergoing coronary artery bypass grafting: A randomized prospective study

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Abstract

Context:

We hypothesized that reduced oropharyngolaryngeal stimulation with video laryngoscopes would attenuate hemodynamic response to laryngoscopy and intubation.

Aim:

Comparison of hemodynamic response to laryngoscopy and intubation with video laryngoscopes and Macintosh (MC) laryngoscope.

Setting and Design:

Superspecialty tertiary care public hospital; prospective, randomized control study.

Methods:

Sixty adult patients undergoing elective coronary artery bypass grafting (CABG) were randomly allocated to three groups of 20 each: MC, McGrath (MG), and Truview (TV). Hemodynamic parameters were serially recorded before and after intubation. Laryngoscopic grade, laryngoscopy, and tracheal intubation time, ST segment changes, and intra-/post-operative complications were also recorded and compared between groups.

Statistical Analysis:

SPSS version 17 was used, and appropriate tests applied. P < 0.05 was considered significant.

Results:

Heart rate and diastolic arterial pressure increased at 0 and 1 min of intubation in all the three groups ( P < 0.05) while mean arterial pressure increased at 0 min in the MG and TV groups and at 1 min in all three groups ( P < 0.05). A significant increase in systolic arterial pressure was only observed in TV group at 1 min ( P < 0.05). These hemodynamic parameters returned to baseline by 3 min of intubation in all the groups. The intergroup comparisons of all hemodynamic parameters were not significant at any time of observation. Highest intubation difficulty score was observed with MC (2.16 ± 1.86) as compared with MG (0.55 ± 0.88) and TV (0.42 ± 0.83) groups ( P = 0.003 and P = 0.001, respectively). However, duration of laryngoscopy and intubation was significantly less in MC (36.68 ± 16.15 s) as compared with MG (75.25 ± 30.94 s) and TV (60.47 ± 27.45 s) groups ( P = 0.000 and 0.003, respectively).

Conclusions:

Video laryngoscopes did not demonstrate any advantage in terms of hemodynamic response in patients with normal airway undergoing CABG.

Related collections

Most cited references 17

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Video-laryngoscopes in the adult airway management: a topical review of the literature.

P Niforopoulou, T Demestiha, T Xanthos … (2010)

The aim of the present paper is to review the literature regarding video-laryngoscopes (Storz V-Mac and C-Mac, Glidescope, McGrath, Pentax-Airway Scope, Airtraq and Bullard) and discuss their clinical role in airway management. Video-laryngoscopes are new intubation devices, which provide an indirect view of the upper airway. In difficult airway management, they improve Cormack-Lehane grade and achieve the same or a higher intubation success rate in less time, compared with direct laryngoscopes. Despite the very good visualization of the glottis, the insertion and advancement of the endotracheal tube with video-laryngoscopes may occasionally fail. Each particular device's features may offer advantages or disadvantages, depending on the situation the anaesthesiologist has to deal with. So far, there is inconclusive evidence indicating that video-laryngoscopy should replace direct laryngoscopy in patients with normal or difficult airways.

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Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation.

A J Shribman, Christopher Davey, J O Ndinya-Achola (1987)

The catecholamine and cardiovascular responses to laryngoscopy alone have been compared with those following laryngoscopy and intubation in 24 patients allocated randomly to each group. Following induction with fentanyl and thiopentone, atracurium was administered and artificial ventilation undertaken via a face mask for 2 min with 67% nitrous oxide in oxygen. Following laryngoscopy, the vocal cords were visualized for 10 s. In one group of patients, ventilation was then re-instituted via a face mask, while in the second group the trachea was intubated during the 10-s period and ventilation of the lungs maintained. Arterial pressure, heart rate and plasma noradrenaline and adrenaline concentrations were measured before and after induction and at 1, 3 and 5 min after laryngoscopy. There were significant and similar increases in arterial pressure and circulating catecholamine concentrations following laryngoscopy with or without intubation. Intubation, however, was associated with significant increases in heart rate which did not occur in the laryngoscopy-only group.

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Comparison of Macintosh, Truview EVO2, Glidescope, and Airwayscope laryngoscope use in patients with cervical spine immobilization.

M. Malik, C Maharaj, B Harte … (2008)

The purpose of this study was to evaluate the effectiveness of the Pentax AWS, Glidescope, and the Truview EVO2, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization. One hundred and twenty consenting patients presenting for surgery requiring tracheal intubation were randomly assigned to undergo intubation using a Macintosh (n=30), Glidescope (n=30), Truview EVO2 (n=30), or AWS (n=30) laryngoscope. All patients were intubated by one of the three anaesthetists experienced in the use of each laryngoscope. The Glidescope, AWS, and Truview EVO2 each reduced the intubation difficulty score (IDS), improved the Cormack and Lehane glottic view, and reduced the need for optimization manoeuvres, compared with the Macintosh. The mean IDS was significantly lower with the Glidescope and AWS compared with the Truview EVO2 device, and the IDS was lowest with the AWS. The duration of tracheal intubation attempts was significantly shorter with the Macintosh compared with the other devices. There were no differences in success rates between the devices tested. The AWS produced the least haemodynamic stimulation. The Glidescope and AWS laryngoscopes required more time but reduced intubation difficulty and improved glottic view over the Macintosh laryngoscope more than the Truview EVO2 laryngoscope when used in patients undergoing cervical spine immobilization.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Card Anaesth

Journal ID (iso-abbrev): Ann Card Anaesth

Journal ID (publisher-id): ACA

Title: Annals of Cardiac Anaesthesia

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0971-9784

ISSN (Electronic): 0974-5181

Publication date (Print): Jan-Mar 2016

Volume: 19

Issue: 1

Pages: 68-75

Affiliations

[1]Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Lok Nayak Hospital, GB Pant and GNEC Hospitals, New Delhi, India

[1 ]Department of Anaesthesiology and Intensive Care, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India

[2 ]Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Associated Maulana Azad Medical College, New Delhi, India

Author notes

Address for correspondence: Prof. Deepak K. Tempe, Maulana Azad Medical College and Associated LNH, GB Pant and GNEC Hospitals, MAMC Complex, New Delhi, India. E-mail: tempedeepak@ 123456hotmail.com

Article

Publisher ID: ACA-19-68

DOI: 10.4103/0971-9784.173023

PMC ID: 4900407

PubMed ID: 26750677

SO-VID: 73b5017b-89b4-47a5-9dd4-4c868336f169

License:

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