Comparison Of Hemodynamic Responses To Three Different Ways Of Intubation

Objective: To compare the hemodynamic responses to endotracheal intubation with Macintosh direct laryngoscope (MDL) , Shikani Optical Stylet(SOS), and fiberoptic bronchoscope (FOB) .Methods: Sixty patients, with American Society of Anesthesiologists (ASA) physical status I～II, aged 18～60 years, and scheduled for surgery under general anesthesia requiring intubation, were randomly allocated equally to MDL group, SOS group, and FOB group .After the routine anesthesia induction, orotracheal intubation was performed with the MDL and the SOS,while nasotracheal intubation was performed with the FOB, respectively noninvasive blood pressure (BP) and heart rate (HR) were recorded before (T₀ values) and after anesthesia induction (T₁ values) , at intubation (T2), and subsequently at an interval of every one minute for a total of three minutes (T₃,T₄,T₅) .Results: All the three groups were similar in the demographic data. After anesthesia induction (T₁), sistolic blood pressure (SBP),diastolic blood pressure (DBP) , mean arterial pressure (MAP) in all the three groups decreased significantly compared to T₀ values (P < 0.05) , while HR had no significant change. After intubation (T₂), DBP,SBP,MAP and HR in all three groups were signifycantly higher than the T₁ values (P < 0.05). In the FOB group at T₂, DBP,SBP,MAP and HR were signify - cantly increased compared with the T₀ values (P < 0.05) .In the MDL group and SOS group, HR at T₂ was significantly higher than the T₀ values ( P <0.05) . In the FOB group, DBP,SBP,MAP at T₂ were significantly increased when compared with the MDL group and the SOS group, and HR was significantly increased compared with the SOS group. In the MDL group, HR at T₂ and T₃ were significantly higher than the SOS group.Conclusion: The hemodynamic responses to endotracheal intubation are most severe in nasal intubation via FOB, followed by MDL, and then SOS, both in oral intubation .