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Hemodynamic and catecholamine response to tracheal intubation: direct laryngoscopy compared with fiberoptic
Michal Barak1, Avishai Ziser, Avital Greenberg
1Department of Anesthesiology, Rambam Medical Center, Haifa, Israel.
Study Objective:
To compare the stress response following tracheal intubation using direct laryngoscopy to that using fiberoptic bronchoscopy technique.
Design:
Randomized, prospective study.
Setting:
Operating rooms in a teaching hospital.
Patients:
51 ASA physical status I and II patients who were scheduled for an elective surgery with general anesthesia.
Interventions:
Patients were randomly assigned to receive either direct laryngoscopy or fiberoptic orotracheal intubation, as part of general anesthesia. A uniform protocol of anesthetic medications was used.
Measurements:
Blood pressure and heart rate were measured before induction, before endotracheal intubation, and 1, 2, 3, and 5 minutes afterwards. Catecholamine (epinephrine and norepinephrine) blood samples were drawn before the induction, and 1 and 5 minutes after intubation.
Main Results:
Duration of intubation was shorter in the direct laryngoscopy group (16.9 (16.9 +/- 7.0 sec, range 8 to 40) compared with the fiberoptic intubation group (55.0 +/- 22.5 sec, range 29 to 120), p < 0.0,001. In both groups, blood pressure and heart rate were significantly increased at 1, 2, and 3 minutes after intubation, but there was no significant difference between the two study groups. Catecholamine levels did not increase after intubation and did not correlate with the hemodynamic changes.
Conclusions:
The use of either direct laryngoscopy or fiberoptic bronchoscopy produces a comparable stress response to tracheal intubation. Catecholamine levels do not correlate with the hemodynamic changes.