COMPARATIVE STUDY OF HAEMODYNAMIC RESPONSE WITH LARYNGOSCOPIC ENDOTRACHEAL INTUBATION AND LARYNGEAL MASKAIRWAY INSERTION IN ADULT HYPERTENSIVE PATIENTS

INTRODUCTION: Laryngoscopy and endotracheal intubation has been the mainstay in providing adequate airway management, delivering general anaesthesia but are associated with hypertension, tachycardia and arrhythmias. These haemodynamic responses may be more hazardous in hypertensive patients. OBJECTIVE: In this study, we aimed to compare the haemodynamic response elicited by laryngoscopic endotracheal intubation with laryngeal mask airway insertion, in ASA II of adult hypertensive patients. METHODS: The study conducted on 100 hypertensive patients of either sex aged between 20 and 60 years belonging to ASA II grade and scheduled for elective surgery. The patients were randomly divided into two groups of 50 patients each. In one group (Group I) laryngoscopic endotracheal intubation was done and in another group (Group II) laryngeal mask airway was inserted. Baseline vitals of the patients (SBP, DBP, MAP, HR, SpO2) were documented. Patients were given inj. Midazolam 2mg IM and Phenargan 25 mg IM as premedication before the elective surgery. General anaesthesia was administered. Haemodynamics including heart rate, blood pressure and SpO2 were recorded every minute till intubation or insertion and at 1,3,5 minutes after intubation or insertion and then every 5 minutes till 20 minutes. RESULTS: All the haemodynamic responses (SBP,DBP,MAP,HR) in Laryngoscopy + Endotracheal Intubation Group compared to the Laryngeal Mask Airway Insertion Group was statistically signi?cant as the p value is <0.05. CONCLUSION: The laryngeal mask airway may be used for airway management during anaesthesia in hypertensive patients on treatment in whom the pressor response would be deleterious.

Comparative Study of IV Esmolol, IV Diltiazem, and IV Lignocaine Hydrochloride in Attenuating Pressure Response to Laryngoscopy and Intubation.

Not many studies have compared more than two drugs in attenuating pressor responses to laryngoscopy and intubation. This study compares four groups of considerable size. The present study compared intravenous esmolol, diltiazem, and lignocaine, for their efficacy to abate pressure response to laryngoscopy and intubation. METHODSThis is a prospective, randomized, double-blinded, controlled clinical study conducted among 220 patients of ASA grade I/II (age 18–60 years), undergoing elective surgical procedure requiring general anaesthesia with endotracheal intubation over a period of 15 months at a tertiary hospital setup. Study subjects were categorised as Groups D, E, L, and N that received diltiazem (0.2 mg/Kg IV), esmolol (2 mg/Kg IV), lignocaine (1.5 mg/Kg IV), and normal saline, respectively; each group had 55 patients. Haemodynamic parameters were recorded at baseline, after drug administration, immediately after intubation, and at 1-, 3-, and 5-minutes after intubation. Data entry and analysis were performed using MS Excel and SPSS-PC-17 version, respectively. One-way ANOVA and the chi-square test were used to evaluate the difference. P < 0.05 was considered significant. RESULTSA maximum increase in haemodynamic parameters occurred immediately after intubation. The increase in heart rate and rate pressure product were significantly lower in Group E (+2.93% & +15.31%), whereas the increase in blood pressure was lower in Group D (8.51%). CONCLUSIONSHaemodynamic stability during laryngoscopy and endotracheal intubation is an integral and essential goal of any anaesthetic management plan and was more effectively maintained with esmolol and diltiazem than with lignocaine.

A Comparative Study of Oral Clonidine and Oral Midazolam as Premedicants for General Anaesthesia

Preanaesthetic medication should be effective and pleasant to be taken orally, have analgesic and non-emetic properties, should not impair cardiovascular stability or depress respiration and produce adequate sedation and anxiolysis. We wanted to compare the effectiveness of oral clonidine and oral midazolam as preanaesthetic medicants.METHODSAfter obtaining the institutional ethical committee clearance and written informed consent, 60 patients, selected for surgery under general anaesthesia were divided by computer generated randomization in Group C (n=30): received Tablet clonidine 150 mcg (0.15 mg) and Group M (n=30): received Tablet midazolam 7.5 mg. Noninvasive blood pressure (systolic, diastolic & mean), respiratory rate, heart rate, degree of sedation, degree of anxiolysis, were recorded at, just before the administration of the any study drug which was 90 minutes before to the induction of anaesthesia, just before to induction of anaesthesia, three minutes after the orotracheal intubation, every 10 minutes for 3 such readings, and three minutes after the orotracheal extubation, and were statistically analysed.RESULTSOral clonidine produced significant attenuation of systolic, diastolic & mean arterial pressure, and reduced respiratory rate, than oral midazolam. Oral midazolam was able to attenuate the pulse rate in a better way than oral clonidine. Oral clonidine produced significant sedation and anxiolysis in comparison to patients who receiving oral midazolam.CONCLUSIONSOral clonidine is the better attenuator amongst the two drugs studied as premedicants to attenuate the cardiovascular responses to laryngoscopy and intubation.

Comparison of Glottic View and Haemodynamic Stress Response Associated with Laryngoscopy using the Macintosh, McCoy and Miller Blades in Adult Patients

Introduction: Laryngoscopy induces haemodynamic responsewhich has implications for patients with cardiovascularillnesses. We devised this study to compare the laryngoscopicview of the glottis obtained with the Macintosh, McCoy andMiller blades, and corresponding haemodynamic changes.Material and Methods: 105 ASA grade I and II patientsrandomly divided into three groups were intubated usingMacintosh, McCoy and Miller blade respectively. Cormackand Lehane grade of glottic view obtained, heart rate, systolicand diastolic blood pressure at baseline, immediately beforeinduction, following induction, and at 1, 3 and 10 minutesafter intubation were noted. Epi Info 7.2 was used forstatistical analysis. Chi square and ANOVA tests were appliedto compare haemodynamic parameters.Results: 18 patients (51.4%) were CL grade I and 17 (48.6%)were CL grade II in Macintosh, 24 (68.6%) were CL gradeI and 11 (31.4%) were CL II in McCoy and, 32 (91.4%)were CL I and 3 (8.6%) were CL II in Miller group. Risein heart rate following intubation was greatest with Millerblade, followed by Macintosh and least with McCoy, andwas statistically significant (P< 0.01). Rise in both, systolicand diastolic blood pressure following intubation was highestwith the Miller blade, followed by Macintosh and least withMcCoy, and the difference compared with baseline values wasstatistically significant (P<0.01).Conclusions: Miller blade provides best visualization of larynxbut McCoy blade produced least haemodynamic response,hence the latter is preferable when less haemodynamicresponse is desired.

Changes In The Haemodynamic Response Following Endotracheal Intubation And Laryngeal Mask Airway Insertion In Hypertensive Patients– A Comparative Study

Endotracheal intubation with the help of a laryngoscope has become a routine part of delivering a general anaesthetic. In general, intubation is indicated for patients who are at risk of aspiration and for those undergoing surgical procedures (1,2).Tracheal intubation causes a reflex increase in sympathetic activity that may result in rise in blood pressure, heart rate, and arrhythmia (3). Achange in plasma catecholamine concentrations also has been demonstrated to be a part of the stress response to tracheal intubation. Various supraglottic devices have provided conflicting evidence of an attenuated haemodynamic response. Materials and Methods:100 Patients divided into two groups (n=50)of 25-60 years of age of either sex with hypertension stage-1 of ASAgrade II on oral anti-hypertensives drugs were selected for the study and endotracheal tube inserted in ETgroup where as LMAinserted in group LMA.Results:Haemodynamics (heart rate, blood pressure, rate pressure product) changes is more in group ETafter induction compared to group LMA.Conclusion:Pressor response and duration of the pressor response to laryngeal mask airway insertion is much less than that of laryngoscopy and endotracheal intubation which establishes the usefulness of LMAin hypertensive patients.

Pre-emptive Use of Oral Pregabalin Attenuates the Pressor Response of Laryngoscopy and Endotracheal Intubation: A Double Blind Randomized Placebo Controlled Study.

Background: Laryngoscopy and intubation may cause undesirable increase in blood pressure and heart rate. The aim of the present study was to investigate the effect of Pregabalin premedication on hemodynamic responses to laryngoscopy and intubation. Methods: Sixty ASA physical status I or II patients undergoing elective surgery under general anesthesia were randomly allocated into two equal groups who received either oral Pregabalin 150 mg (Group PB)or placebo (Group PL)1 hour prior to surgery. Heart rate, Systolic, Diastolic and Mean arterial blood pressures were recorded preoperative, at laryngoscopy and 0,1,3,5 and 10 minutes after tracheal intubation. Results: Demographic data and base-line values for Heart rate, Systolic, Diastolic and Mean arterial blood pressures were comparable between groups. During laryngoscopy and intubation there was significant attenuation of SBP, DBP and MBP in PB group as compared to PL group. Although increase in heart rate was less in pregabalin group during laryngoscopy and intubation but it was not statistically significant. Conclusion: In the present study design, oral Pregabalin premedication at a dose of 150 mg one hour prior to surgery attenuates pressor response associated with laryngoscopy and endotracheal intubation but not the tachycardia significantly.

A randomised comparative study of the effect of Airtraq optical laryngoscope vs. Macintosh laryngoscope on intraocular pressure in non-ophthalmic surgery / Estudo comparativo randomizado do efeito do laringoscópio óptico Airtraq vs. laringoscópio Macintosh sobre a pressão intraocular em cirurgia não oftálmica

BACKGROUND: We compared intraocular pressure changes following laryngoscopy and intubation with conventional Macintosh blade and Airtraq optical laryngoscope. METHODS: Ninety adult patients were randomly assigned to study group or control group. Study group (n = 45) - Airtraq laryngoscope was used for laryngoscopy. Control group (n = 45) - conventional Macintosh laryngoscope was used for laryngoscopy. Preoperative baseline intraocular pressure was measured with Schiotz tonometer. Laryngoscopy was done as per group protocol. Intraocular pressure and haemodynamic parameters were recorded just before insertion of the device and subsequently three times at an interval of one minute after insertion of the device. RESULTS: Patient characteristics, baseline haemodynamic parameters and baseline intraocular pressure were comparable in the two groups. Following insertion of the endotracheal tube with Macintosh laryngoscope, there was statistically significant rise in heart rate and intraocular pressure compared to Airtraq group. There was no significant change in MAP. Eight patients in Macintosh group had tongue-lip-dental trauma during intubation, while only 2 patients received upper airway trauma in Airtraq group. CONCLUSION: We conclude that Airtraq laryngoscope in comparison to Macintosh laryngoscope results in significantly fewer rises in intraocular pressure and clinically less marked increase in haemodynamic response to laryngoscopy and intubation.

JUSTIFICATIVA: Comparar as alterações de pressão intraocular após laringoscopia e intubação com lâmina Macintosh convencional e laringoscópio óptico Airtraq. MÉTODOS: Noventa pacientes adultos foram randomicamente designados para os grupos estudo ou controle. No grupo estudo (n = 45) o laringoscópio Airtraq foi usado para laringoscopia e no grupo controle (n = 45) o laringoscópio Macintosh convencional foi usado para laringoscopia. A pressão intraocular foi mensurada no pré-operatório com tonômetro Schiotz. A laringoscopia foi feita de acordo com o protocolo de cada grupo. Pressão intraocular e parâmetros hemodinâmicos foram registrados logo antes da inserção do dispositivo e três vezes após a inserção do dispositivo, com intervalo de um minuto. RESULTADOS: As características dos pacientes, os parâmetros hemodinâmicos basais e a PIO basal foram comparáveis nos dois grupos. Após a inserção do tubo endotraqueal com o laringoscópio Macintosh, houve um aumento estatisticamente significativo da frequência cardíaca e da pressão intraocular em comparação com o grupo Airtraq. Não houve alteração significativa da PAM. Oito pacientes do grupo Macintosh sofreram trauma de língua-lábio-dental durante a intubação, enquanto apenas dois pacientes sofreram trauma das vias aéreas superiores no grupo Airtraq. CONCLUSÃO: Concluímos que o laringoscópio Airtraq, em comparação com o laringoscópio Macintosh, resultou em elevações significativamente menores da PIO e em aumentos clinicamente menos acentuados da resposta hemodinâmica à laringoscopia e intubação.