Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 6147  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (72 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References

 Article Access Statistics
    Viewed6864    
    Printed102    
    Emailed2    
    PDF Downloaded134    
    Comments [Add]    
    Cited by others 1    

Recommend this journal


 


 
EXPERT'S COMMENTS
Year : 2005  |  Volume : 51  |  Issue : 4  |  Page : 264-265

Hemodynamic changes during laryngoscopy: Does it matter?


Departement d’Anesthesie-Reanimation, Hopital Timone Marseille, France

Correspondence Address:
N Bruder
Departement d’Anesthesie-Reanimation, Hopital Timone Marseille
France
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions




How to cite this article:
Bruder N. Hemodynamic changes during laryngoscopy: Does it matter?. J Postgrad Med 2005;51:264-5

How to cite this URL:
Bruder N. Hemodynamic changes during laryngoscopy: Does it matter?. J Postgrad Med [serial online] 2005 [cited 2020 Jan 20];51:264-5. Available from: http://www.jpgmonline.com/text.asp?2005/51/4/264/19234


The article convincingly demonstrates in a large group of patients that, when tracheal intubation is not difficult, laryngoscopy is less stressful with the McCoy laryngoscope than with the classical MacIntosh blade, allowing to use less fentanyl for laryngoscopy.

Are short-term changes in blood pressure clinically relevant in ASA I-II patients undergoing elective surgery? Is it interesting to use 2 mg/kg less fentanyl for elective neurosurgical patients during anesthesia? The answer is probably no for both questions! So, what does this study mean and why are there so many studies on the hemodynamic changes associated with tracheal intubation? Because anesthetic management is not so easy in the real world. Certainly every anesthesiologist has seen large drops in blood pressure with the association of low doses fentanyl and thiopental for induction of anesthesia in emergency or unstable patients. It is also not rare to observe unpredictable severe hypertension after laryngoscopy. In a few patients, both hypotension and hypertension may have disastrous consequences. This is especially true for emergency neurosurgery. Aneurysm rupture has been reported as a consequence of hypertension during tracheal intubation.[1] But hypotension in patients with intracranial hypertension may critically decrease cerebral perfusion pressure leading to cerebral ischemia. Hemodynamic stability and prevention of hypertensive events are also critical for the management of acute aortic dissection[2] or in patients with severe coronary artery disease.[3] Thus, it is clear that in some patients hemodynamic stability during induction of anesthesia and tracheal intubation is both desirable and difficult to achieve. By decreasing the amount of anesthetic agents necessary to perform laryngoscopy, the McCoy laryngoscope may be a simple and valuable tool in difficult hemodynamic situations.

However, this study has several limitations. First, the authors excluded patients with difficult intubation. As the pressure applied to the laryngoscope increases, the difference between laryngoscopes will probably disappear. Second, the authors did not measure the duration of laryngoscopy, a factor, which has been shown to be closely related to the pressure response.

Finally, this study opens new prospects. It is reasonable to assume that a less painful laryngoscopy, would improve the quality of intubation particularly when it is desirable to avoid neuromuscular blockers. It seems clear that the quality of intubation contributes to laryngeal morbidity.[4],[5] It has to be demonstrated whether or not the McCoy laryngoscope is able to decrease airway injury.



 
 :: References Top

1.Eng CC, Lam AM, Byrd S, Newell DW. The diagnosis and management of a perianesthetic cerebral aneurysmal rupture aided with transcranial Doppler ultrasonography. Anesthesiology 1993;78:191-4.  Back to cited text no. 1  [PUBMED]  
2.Padro JM, Caralps JM, Garcia J, Aris A. Spontaneous rupture of the ascending aorta. J Cardiovasc Surg (Torino) 1988;29:109-10.  Back to cited text no. 2  [PUBMED]  
3.Haessler R, Madler C, Klasing S, Schwender D, Peter K: Propofol/fentanyl versus etomidate/fentanyl for the induction of anesthesia in patients with aortic insufficiency and coronary artery disease. J Cardiothorac Vasc Anesth 1992;6:173-80.  Back to cited text no. 3    
4.Maktabi MA, Smith RB, Todd MM. Is routine endotracheal intubation as safe as we think or wish? Anesthesiology 2003;99:247-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Mencke T, Echternach M, Kleinschmidt S, Lux P, Barth V, Plinkert PK, Fuchs-Buder T. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anesthesiology 2003;98:1049-56.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]



This article has been cited by
1 Anaesthesia for direct laryngoscopy with propofol and fentanyl or sufentanil
Srivastava, U., Mishra, A.R., Sharma, S., Kumar, D., Kumar, A., Saxena, S., Khan, I.
Indian Journal of Otolaryngology and Head and Neck Surgery. 2008; 60(4): 314-316
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article
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