Comparison Of Stress Response Performing Endotracheal Intubation By Direct Laryngoscopy, Fibreoptic Intubation And Intubation By The Glidescope Laryngoscope

Abstract

Comparison Of Stress Response Performing Endotracheal Intubation By Direct Laryngoscopy, Fibreoptic Intubation And Intubation By The Glidescope Laryngoscope Stress response is regulated by two primary neuroendocrine systems—the hypothalamuspituitary- adrenocortical (HPA) and sympathetic adrenomedullary (SAM) systems. Salivary alphaamylase (AA) levels can be used as an index of the SAM activity, and serum cortisol as an index of HPA activity. The aim of the study was to compare patient stress response to different intubation techniques. Sixty adult patients, ASA I-III, scheduled for elective abdominal surgery were included in this study, with median age of 54±18 years. Patients were prospectively randomly divided into three groups-intubation with a GlideScope (GS), Macintosh laringoscope (ML) and PENTAX fibreoptic bronchoscope (FB). After preoxygenation for 3 min anaesthesia was induced with fentanyl 2 mkg/kg, mivacuronium 0.2 mg/kg and propofol 2 mg/kg, injected intravenously over 20 seconds. Intubation was started 2 min after mivacuronium injection. Anaesthesia was maintained with sevoflurane 1-2 vol% and fentanyl 1 mkg/kg as needed. Intubation time (IT) was measured, blood and saliva samples were collected before and shortly after intubation. Haemodynamic response was recorded. Intubation time was statistically significantly longer in the FB group (120±65 s) versus the ML group (29±5 s) and GS group (26±9 s), P < 0.05. In the three patients groups the initial AA level was similar (54±20 KU/ml, P > 0.05). In GS patients the alpha amylase level after intubation significantly decreased (42±15 KU/ml, P < 0.05), but in ML and FB patients—significantly increased (68±24 KU/ml and 73±32 KU/ml, respectively, P < 0.05). After intubation, blood cortisol did not differ between the ML (377±181 U/ml) and GS (484±61 U/ml) patient groups, but was significantly higher (P < 0.05) in the FB group (530±79 U/ml). Both heart rate and blood pressure increased during intubation, the difference between groups was not significant. All intubations were successful, but in the FB patient group IT was significantly longer than in the ML and GS patient group. IT in the GS and FB patient groups did not statistically significantly differ. In our opinion, shorter and more confident intubations with a GlideScope produce less nociceptive stimulus and less stress to the patient. Intubations using GlideScope videolaryngoscope causes lesser stress response in comparison to intubation with a Macintosh laryngoscope or fibreoptic bronchoscope.

Biochemical markers and haemodynamic changes of stress response after intubation with direct laryngoscopy versus video laryngoscopy versus fiberoptic intubation: A comparative study

“…1,2 Thus, in VL group pre and post-intubation change in level of salivary alpha amylase was insignificant (p=0.919), but it was highly significant(p=0.0001), in DL and FOB group, which shows that Video laryngoscopy causes least neuroendocrine stress response to intubation in comparison to Direct laryngoscopy and Fiberoptic group. Our result was well supported by Natalja et al (2008), 7 who studied comparison of stress response performing intubation by direct laryngoscopy, fiberoptic intubation and the glidescope video laryngoscope and concluded that shorter and more confident intubations with a glide scope produces less nociceptive stimulus and less stress to the patient. In VL patient the SAA level after intubation significantly decreased, but in ML and FOB patients significantly increased.…”

“…This shows that in stress response, both neuroendocrine systems (HPA and SAM) are of importance and can react differently. 3 Observing the above facts in our study it can be said that intubation with fiberoptic requires the longest time, causing the greatest pressor response 5,6 to the patients while, intubation with video laryngoscopy causes lesser stress response 4,7 to the patients. Thus, the video laryngoscope is a reliable technique for patient's safety.…”

“…5 In Direct laryngoscopy, variable amount of force is applied during visualization of the glottis and tracheolaryngeal manipulation during advancement of ET tube into the trachea 1,2 and in FOB, prolonged tracheal stimulation, jaw thrust maneuver and external neck manipulation contribute to the haemodynamic response. 6,7 This again shows that VL group is associated with less stress response comparative to DL and FOB groups. Natalja et al (2008) 7 in their study found that after intubation, the cortisol level in blood serum did not significantly differ between the ML and GS patient groups, but was significantly higher (P < 0.05) in the FOB patient group.…”

“…6,7 This again shows that VL group is associated with less stress response comparative to DL and FOB groups. Natalja et al (2008) 7 in their study found that after intubation, the cortisol level in blood serum did not significantly differ between the ML and GS patient groups, but was significantly higher (P < 0.05) in the FOB patient group. We also compared HDSR in terms of MAP at different time interval (Table 4).…”

“…Mean intubation time on the basis of intubation techniques, which was maximum for fiberoptic laryngoscopy and minimum in case of direct laryngoscopy. Natalja et al 7 found that endotracheal intubation with a Fiberoptic intubation required the longest time and caused the most pronounced stress response. A significantly longer intubation time in the FOB patient group might be explained by the fact that before the intubation the patients were introduced muscle relaxant.…”