Circulatory responses to fiberoptic intubation in anesthetized children: a comparison of oral and nasal routes.
BACKGROUND
Previous studies have demonstrated a significant difference in the circulatory responses in adults to fiberoptic nasotracheal intubation (FNI) and fiberoptic orotracheal intubation (FOI). But, it is unknown whether there is a clinically relevant difference in the circulatory responses in children to these two intubation methods.


METHODS
In this randomized clinical study, we compared the arterial blood pressure and heart rate changes during FNI and FOI in 66 children, ASA physical status I-II, aged 3-9 yr scheduled for elective plastic surgery. After anesthesia induction with fentanyl-propofol and vecuronium, fiberoptic intubation was performed. Noninvasive arterial blood pressure and heart rate were recorded before (baseline values) and after anesthesia induction (postinduction values), at intubation, and every minute for the first 5 min after intubation. The maximum values of arterial blood pressure and heart rate during the observation were also recorded.


RESULTS
The total intubation time was significantly longer in the FNI group than in the FOI group. Both FOI and FNI caused significant increases in arterial blood pressure and heart rate compared with the baseline and postinduction values. Arterial blood pressure and heart rate at intubation and after intubation, and their maximum values during the observed periods were significantly lower in the FNI group compared with the FOI group. The times required to reach the maximum values of systolic blood pressure and heart rate were significantly longer in the FNI group than in the FOI group, but the times required for recovery of systolic blood pressure and heart rate to postinduction values were significantly shorter in the FNI group than in the FOI group. After the intubation, the times required to reach the peak levels of systolic blood pressure and heart rate were not significantly different between the two groups.


CONCLUSIONS
Both FOI and FNI can cause significant circulatory responses in healthy anesthetized children, and the circulatory responses to FNI are fewer and of a shorter duration than those to FOI.
Xue
Fu S
FS
Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China. fruitxue@yahoo.com.cn
Li
Cheng W
CW
Liu
Kun P
KP
Sun
Hai T
HT
Zhang
Guo H
GH
Xu
Ya C
YC
Liu
Yi
Y
D000758:Anesthesia / Q000009:adverse effects / Q000379:methods*; D001775:Blood Circulation / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005336:Fiber Optic Technology / Q000379:methods*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007440:Intubation / Q000009:adverse effects / Q000379:methods; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D008297:Male; D009296:Nasal Cavity