Comparing GlideScope Video Laryngoscope and Macintosh Laryngoscope Regarding Hemodynamic Responses during Orotracheal Intubation: A Randomized Controlled Trial

Abstract

Background:To determine if the GlideScope® videolaryngoscope (GVL) could attenuate the hemodynamic responses to orotracheal intubation compared with conventional Macintosh laryngoscope.Objectives:The aim of this relatively large randomized trial was to compare the hemodynamic stress responses during laryngoscopy and tracheal intubation using GVL versus MCL amongst healthy adult individuals receiving general anesthesia for elective surgeries.Patients and Methods:Ninety five healthy adult patients with American Society of Anesthesiologists physical status class I or II that were scheduled for elective surgery under general anesthesia were randomly allocated to either Macintosh or GlideScope arms. All patients received a standardized protocol of general anesthesia. Hemodynamic changes associated with intubation were recorded before and at 1, 3 and 5 minutes after the intubation. The time taken to perform endotracheal intubation was also noted in both groups.Results:Immediately before laryngoscopy (pre-laryngoscopy), the values of all hemodynamic variables did not differ significantly between the two groups (All P values > 0.05). Blood pressures and HR values changed significantly over time within the groups. Time to intubation was significantly longer in the GlideScope (15.9 ± 6.7 seconds) than in the Macintosh group (7.8 ± 3.7 sec) (P< 0.001). However, there were no significant differences between the two groups in hemodynamic responses at all time points.Conclusions:The longer intubation time using GVL suggests that the benefit of GVL could become apparent if the time taken for orotracheal intubation could be decreased in GlideScope group.

The Effect of Intubation with Video and Conventional Laryngoscopy on Hemodynamic Response

“…Especially increased HR increases the risk of cardiovascular events by increasing myocardial oxygen consumption [3] . Different results have been reported in studies that explored the effects of VL and DL on hemo-dynamic response in the literature [10,13,14,[16][17][18] . In some studies, the effects of VL and conventional DL methods on hemodynamic response were found to be similar [14,16,17] .…”

“…Different results have been reported in studies that explored the effects of VL and DL on hemo-dynamic response in the literature [10,13,14,[16][17][18] . In some studies, the effects of VL and conventional DL methods on hemodynamic response were found to be similar [14,16,17] . The hemodynamic parameters immediately after ET and at the 2nd min were reported as similar in patients scheduled for cardiac surgery and intubated with C-MAC VL (Macintosh blade) and conventional Macintosh DL methods [14] .…”

A Comparative Study of Haemodynamic Responses to Laryngoscopy and Endotracheal Intubation With Direct Laryngoscope and Video Laryngoscope in Patients Posted for Coronary Artery Bypass Grafting

“…[1] Although these changes are usually transient they can be dangerous in susceptible patients resulting in morbidity and mortality and can be detrimental in patients with cardiovascular disease. [4,5] Pharmacologic interventions might depress the cardiovascular system resulting in undesired hypotension and bradycardia. [6] Increasing the depth of anaesthesia can blunt these deleterious effects; however, changes in the concentration of anaesthetic agents in blood occur slowly in relation to the onset and offset of airway stimuli and haemodynamic responses.…”

Comparison of hemodynamic responses to endotracheal intubation with the GlideScope video laryngoscope and Macintosh laryngoscope in patients undergoing cardiovascular surgery

“…They did not observe any difference in hemodynamic response between the groups and attributed this to the fact that tracheal stimulation was a major factor for hemodynamic response. [8,14,22,25,30] Similarly, Pournajafian et al [32] also reported that no difference in hemodynamic responses in normotensive patients but they reported increased intubation time with GlideScope. Our results were consistent with these studies; however, laryngoscopy time was similar in both groups in our study.…”

“…Xue et al [20] reported 28.4±1.7 sec and 37.4±9.9 sec respectively for Macintosh and GlideScope laryngoscopes while defining intubation time as "the period from the termination of manual ventilation using a face mask to the resuming of ventilation through a tracheal tube". Pournajafian et al [32] defined intubation time as "time from insertion of assigned intubating device into the mouth up to the time the tracheal tube positioned between vocal cords" and they reported 7.8±3.7 sec and 15.9±6.6 sec respectively for Macintosh and GlideScope laryngoscopes. However, the investigator in this study had no previous experience and had only performed 20 successful intubations with GlideScope under supervision before the study.…”