Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway

OBJECTIVES: We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients. METHODS: Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded. RESULTS: The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04±19.8 s, respectively) (p<0.001). The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05). The rate pressure product values (heart rate x systolic blood pressure) at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively) were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively) (p<0.05). There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754). The number and type of airway complications were similar between the groups. CONCLUSION: The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from conventional laryngoscopy in hypertensive patients. As ST changes and upper airway morbidity are similar between the two techniques, conventional laryngoscopy, which is rapid and safe to perform, may be preferred in hypertensive patients with normal airways.

" TOTI " Method for Difficult Orotracheal Intubation in Adult Patients / 대한마취과학회지

This report is a prospective study comparing conventional direct laryngoseopy with tube-over-tube intubation ("TOTI") method in 42 male patients, whose tracheas were difficult to intubate. ("TOTI") method using two different-sized endotracheal tubes, the newly devised technique has not been mentioned yet. And the comparative studies have not been performed to evaluate relative efficacy, speed, or incidence of complications for the conventional versus "TOTI" method in endotracheal intubation. Overall number of attempts (mean+/-SE) in conventional group was 3.62+/-0.37(range; 1-8), while "TOTI" one was 1.1+/-0.07 (range; 1-2). The time required for intubation ranged from 25 to 64 seconds in TOTI group and 37 to 2015 sec in conventional one, average (mean+/-SE) 37.19+/-1.87 and 542.71+/-111.54sec, respectively. No complications of endotracheal intubation occured in "TOTI" group, whereas in coventional one there occurred fourteen patients with sore throat, seven with hoarseness and five with temporary short-lived dysrhythmia.