Lightwand intubation is associated with less hemodynamic changes than fibreoptic intubation in normotensive, but not in hypertensive patients over the age of 60.
OBJECTIVE
To compare the effects of the lightwand and fibreoptic techniques for intubation, neither of which require laryngoscopy, on hemodynamic responses associated with tracheal intubation in normotensive and hypertensive elderly patients.


METHODS
Eighty-eight normotensive and hypertensive patients aged more than 60 yr were randomly allocated to either the lightwand (LN and LH group, n=22 in both) or the fibreoptic group (FN and FH group, n=22 in both). All intubations were performed after induction of anesthesia with fentanyl and propofol and muscle relaxation with vecuronium. Systolic and mean arterial pressures (SAP and MAP) and heart rate (HR) were recorded, and rate-pressure product (RPP) and the change from "before intubation" to "immediately after intubation" of each variable (triangle upMAP triangle up,HR and triangle upRPP) were calculated.


RESULTS
In normotensive patients, significantly smaller triangle upMAP, triangle upHR and triangle upRPP were observed in the LN group than in the FN group (P <0.05). In hypertensive patients, no significant differences between the LH group and the FH group were found in triangle upMAP or triangle upHR, while values of mean RPP in both groups were less than 20,000.


CONCLUSIONS
We conclude that the lightwand technique significantly attenuates hemodynamic changes following intubation in comparison with fibreoptic intubation in normotensive patients over the age of 60. Hemodynamic changes following intubation using the lightwand technique and the fibreoptic technique in hypertensive elderly patients are similar. However, both techniques are useful for intubation in hypertensive elderly patients in terms of RPP.
Nishikawa
K
K
Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, Japan. hokuseiope@mac.com
Kawamata
M
M
Namiki
A
A
D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D020680:Bronchoscopes / Q000009:adverse effects*; D005260:Female; D005336:Fiber Optic Technology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D010101:Oxygen Consumption / Q000502:physiology