Hemodynamic and catecholamine response to tracheal intubation: direct laryngoscopy compared with fiberoptic intubation.
OBJECTIVE
To compare the stress response following tracheal intubation using direct laryngoscopy to that using fiberoptic bronchoscopy technique.


METHODS
Randomized, prospective study.


METHODS
Operating rooms in a teaching hospital.


METHODS
51 ASA physical status I and II patients who were scheduled for an elective surgery with general anesthesia.


METHODS
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.


METHODS
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.


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.
Barak
Michal
M
Department of Anesthesiology, Rambam Medical Center, Haifa, Israel.
Ziser
Avishai
A
Greenberg
Avital
A
Lischinsky
Sophie
S
Rosenberg
Beno
B
D000328:Adult; D000768:Anesthesia, General; D001794:Blood Pressure; D001999:Bronchoscopy; D004837:Epinephrine / Q000097:blood*; D005260:Female; D005336:Fiber Optic Technology; D006339:Heart Rate; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D009638:Norepinephrine / Q000097:blood*; D011446:Prospective Studies; D013312:Stress, Physiological / Q000209:etiology / Q000503:physiopathology
D009638:Norepinephrine; D004837:Epinephrine