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| Year : 2005 | Volume
: 51
| Issue : 4 | Page : 264-265 |
Hemodynamic changes during laryngoscopy: Does it matter?
N Bruder
Departement d’Anesthesie-Reanimation, Hopital Timone Marseille, France
Correspondence Address:
N Bruder
Departement d’Anesthesie-Reanimation, Hopital Timone Marseille
France
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Bruder N. Hemodynamic changes during laryngoscopy: Does it matter?. J Postgrad Med 2005;51:264-5 |
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 | |  |
| 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.  [PUBMED] |
| 2. | Padro JM, Caralps JM, Garcia J, Aris A. Spontaneous rupture of the ascending aorta. J Cardiovasc Surg (Torino) 1988;29:109-10. [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. |
| 4. | Maktabi MA, Smith RB, Todd MM. Is routine endotracheal intubation as safe as we think or wish? Anesthesiology 2003;99:247-8. [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. [PUBMED] [FULLTEXT] |
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Anaesthesia for direct laryngoscopy with propofol and fentanyl or sufentanil |
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| 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] | |
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