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 ORIGINAL ARTICLE
Year : 2005  |  Volume : 51  |  Issue : 4  |  Page : 260-264

Opioid sparing during endotracheal intubation using mccoy laryngoscope in neurosurgical patients: The comparison of haemodynamic changes with macintosh blade in a randomized trial


1 Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibarely Road, Lucknow, India
2 Department of Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibarely Road, Lucknow, India

Correspondence Address:
Prabhat Tewari
Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibarely Road, Lucknow
India
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Source of Support: None, Conflict of Interest: None


PMID: 16388166

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Background: There is conflicting data in literature to show that the McCoy laryngoscope is less stressful and opioids can actually be avoided during laryngoscopy and intubation with the use of this laryngoscope. Aim: A comparison of hemodynamic changes with McCoy vs Macintosh laryngoscope.. Settings and Design: 180 ASA I and II neurosurgical patients undergoing elective surgery for space occupying lesions were recruited. The study was was prospective, randomized and blinded in the setting of neurosurgical perioperative services. Methods and Materials: The patients were divided into four groups (Gr.1 McCoy and fentanyl; Gr. 2 McCoy and no fentanyl; Gr. 3 Macintosh and fentanyl; Gr. 4 Macintosh and no fentanyl). In Gr. 2 and 4 equivalent volume of saline was given in place of fentanyl as placebo. Heart rate, systolic and diastolic blood pressure were measured after laryngoscopy, after intubation and subsequently every minute for the next five minutes. The incidence of cough due to fentanyl treatment was observed. Statistical Analysis: Haemodynamic changes were compared between and within groups using oneway ANOVA and repeated measures ANOVA. All analysis included 95% CI at 5% significance. The Mann Whitney U test was used for comparing incidence of cough. Results: No difference was found between McCoy laryngoscopy when done with or without fentanyl pretreatment (HR p =0.848, sys BP p =0.229 and diastolic blood pressure p =0.981). Significant changes in haemodynamic parameters were seen between Macintosh and McCoy laryngoscopy without fentanyl pretreatment ( p <0.001) whereas changes were blunted with fentanyl pretreatment in Macintosh laryngoscopy ( p <0.05). Conclusions: McCoy laryngoscope blade is less stressful and fentanyl pretreatment is not necessary to attenuate haemodynamic responses with its use in ASA I and II patients.






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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow