Attenuating the Hypertensive Response to Laryngoscopy and Endotracheal Intubation Using Awake Fibreoptic Intubation

Abstract

Blood pressure and pulse rate measurements were recorded in 35 patients undergoing endotracheal intubation during general anaesthesia (Group A), and 35 patients who had an awake fibreoptic intubation under local anaesthesia (Group B). The mean arterial pressure in Group A rose by a mean of 35 mmHg immediately after intubation, compared with a mean fall of 9 mmHg in Group B. The mean pulse rate in Group A rose by 24 beats per minute (b.p.m.) immediately after intubation, compared with a rise of 3 b.p.m. in Group B. Both these differences were statistically significant (P< 0.0001 and P < 0.001 respectively, Mann Whitney U test). Postoperative discomfort was assessed 24 h later by means of linear analogue scales. There was a statistically higher mean score in relation to nose discomfort in Group B (P<0.002). Awake fibreoptic intubation successfully reduces the pressor response to endotracheal intubation in normotensive adults. It'is suitable for use in those patients who are at risk from the pressor response.

Blood pressure and heart rate changes during intubation: a comparison of direct laryngoscopy and a fibreoptic method

“…Other studies have demonstrated that tracheal tube insertion is the most invasive stimulus during the intubation manipulation [9, 10]. Thus, the circulatory responses to tracheal intubation may not be alleviated by avoiding laryngoscopic stimulation to the epiglottis and the base of the tongue unless the trachea is adequately pretreated with local anaesthetics [4, 11].…”

The circulatory responses to fibreoptic intubation: a comparison of oral and nasal routes

“…This might be the main reason why the tachycardic response to FNI was shorter than that to FOI. Fourth, some studies have demonstrated that tracheal tube insertion is the most invasive stimulus during the intubation procedure and may be another important cause of the circulatory responses to tracheal intubation [2, 12, 27]. Fifth, the fibreoptic bronchoscope and tracheal tube passing through the nasal cavity tend to be more aligned with the laryngeal and tracheal axes than when introduced through the mouth because there is no sharp turn between choanae and the laryngeal aperture [28, 29].…”

“…The increasing use of fibreoptic bronchoscopy in clinical anaesthesia has drawn attention to the circulatory responses during fibreoptic intubation. Many relevant studies have been carried out in this field [1–13], but despite the tremendous differences in the airway stimuli caused by nasal and oral intubations, only one small study [14] has compared the circulatory responses to fibreoptic orotracheal intubation (FOI) and fibreoptic nasotracheal intubation (FNI) under a combination of neuroleptic analgesia and topical anaesthesia. The present randomised clinical study was designed therefore to investigate in a larger sample whether there is a clinically relevant difference between the circulatory responses to FOI and FNI when carried out by experienced practitioners in healthy, female patients receiving general anaesthesia.…”

Fibreoptic Intubation Skills among Anaesthetists in New Zealand

“…Potential harm to the patient is often cited as a reason to avoid practice in the patient. Fibreoptic intubation was associated with greater cardiovascular changes than intubation using a Macintosh laryngoscope, raising ethical concerns over providing training in this method 10. However, the safety of FOI, whether performed by trainees or consultants, has been reaffirmed 23,33,34 . A high level of acceptance for awake FOI is reported amongst patients with no indication for FOI, other than teaching 23,35,36 .…”