Hemodynamic response to tracheal intubation in postlaryngectomy patients

Endotracheal intubation in postlaryngectomy patients is usually accomplished by inserting endotracheal tube directly into the laryngectomy stoma. The primary objective of our study was to assess the systolic blood pressure (SBP) response to intubation in postlaryngectomy patients. Secondary objectives included assessment of changes in heart rate (HR), mean arterial pressure (MAP), and to estimate tracheal component of hemodynamic response to intubation in normal patients by finding out the relative reduction in hemodynamic response that might occur in postlaryngectomy patients.

This was a prospective, observational study. Forty postlaryngectomy patients formed group L and 40 normal patients constituted group N. After induction of anesthesia and neuromuscular blockade, direct laryngoscopy and tracheal intubation were performed in group N, whereas an endotracheal tube was passed through the laryngectomy stoma directly into the trachea in group L. Hemodynamic responses were documented. Chi-square test, independent samples t-test, and analysis of covariance (ANCOVA) test were applied.

Group L patients were significantly older with significantly lower baseline HR with higher SBP and MAP. As baseline values were not comparable, they were taken as covariates and ANCOVA was applied. Adjusted mean values were then compared. Immediately after induction HR, SBP and MAP were comparable in both groups. Subsequent comparison of adjusted mean values showed significantly higher HR, SBP, and MAP in group N immediately after intubation and 1,3,5, and 10 min later (P < 0.001). At 15 min, HR and SBP were significantly higher in group N with comparable MAP.

Hemodynamic stress response to endotracheal intubation is minimal or absent in postlaryngectomy patients. They mostly present with elevated blood pressure and develop hypotension following induction that persists despite intubation.