Comparison of Hemodynamic Response and Complications in Patients with Difficult Airway Using Two Techniques-Retrograde and Fibreoptic Intubation

Abstract

Objective: The Aim of this study was to identify the hemodynamic response and success rate to awake retrograde endotracheal intubation (REI) and fiberoptic bronchoscope (FOB) assisted endotracheal intubation in difficult airway situation and to validate whether the REI can attenuate the hemodynamic response to tracheal intubation compared with the FOB assisted intubation. Design: Randomized Prospective Study.Methods: 64 adults, ASA I-II scheduled for elective surgery requiring endotracheal intubation were randomly allocated to either the awake REI group (n=32) or the FOB group (n=32). Non-invasive blood pressure (NIBP), heart rate (HR) and Spo 2 were recorded. Time taken for intubation and success rate of intubation during the observation was also recorded.Results: During awake intubation, the magnitude of change of both NIBP and HR was greatest in Group REI as compare to Group FOB. Time taken for intubation and success rate were better in FOB group, while complication like airway trauma was higher in awake retrograde intubation group (REI).Conclusions: Awake Endotracheal intubation using FOB and REI in adult may cause increases in MAP and HR. However we observed maximum increase in heart rate and MAP occurred at the end of intubation in REI group than FOB, while time taken for intubation were lesser and success rate of intubation were superior in FOB as compare to REI group.

Temporomandibular Joint Ankylosis: Anesthetic Challenge

“…In a 2017 study, Pokhriyal et al compared the hemodynamic response and success rate of awake retrograde endotracheal intubation (REI) and fiberoptic bronchoscope (FOB) assisted endotracheal intubation in difficult airway situations. They found that the maximum increase in heart rate and mean arterial pressure (MAP) occurred at the end of intubation in the REI group compared to the FOB group, while the FOB group's intubation took less time and had a higher success rate than the REI group [14]. In their retrospective observational analysis, Kriege et al found that tracheal intubation performed while awake was linked to a decreased rate of serious adverse outcomes compared to tracheal intubation performed while anesthetized [15].…”