Heart rate/blood pressure response and airway morbidity following tracheal intubation with direct laryngoscopy, GlideScope and Trachlight: a randomized control trial.
OBJECTIVE
Haemodynamic response to tracheal intubation might be detrimental in high-risk patients. Minimizing oropharyngo-laryngeal stimulation or avoiding laryngoscopy may attenuate this response. We hypothesized that intubations performed with GlideScope or Trachlight would generate a lesser haemodynamic response than the conventional method of direct laryngoscopy. The objective of this study was to compare the haemodynamic response following tracheal intubation, using three different techniques of intubation. We also examined postoperative airway morbidities as our secondary outcome.


METHODS
This was a prospective randomized control trial, conducted at Mount Sinai Hospital of Toronto. After Ethics Board approval, 60 adult ASA status I and II patients, scheduled for elective surgery requiring general anaesthesia with orotracheal intubation, were randomly allocated into three groups. Intubation was performed by a single experienced anaesthesiologist, using direct laryngoscopy, GlideScope or Trachlight. The haemodynamic variables were measured noninvasively at specific time intervals. We also recorded the number of attempts and total time for intubation. Postoperative airway symptoms following surgery were assessed using a questionnaire.


RESULTS
There was no significant difference in blood pressure and heart rate between the groups. Direct laryngoscopy intubation times were significantly lower than those of the other techniques (both P<0.0001). The occurrence of sore-throat symptoms in recovery was significantly higher in the Trachlight group (P=0.0033).


CONCLUSIONS
There was no benefit of using any of the three intubation techniques for attenuation of haemodynamic changes. There was a higher incidence of airway symptoms associated with Trachlight intubation.
Siddiqui
Naveed
N
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. naveed.siddiqui@uhn.on.ca
Katznelson
Rita
R
Friedman
Zeev
Z
D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002985:Clinical Protocols; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006685:Hoarseness / Q000517:prevention & control; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000517:prevention & control; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult