Blood pressure, heart rate and catecholamine response during riberoptic nasotracheal intubation under general anesthesia

Abstract

Arterial blood pressure (ABP) and heart rate were recorded at one-minute intervals during several stages of intubation in the fiberscope group and the laryngoscope group, to determine if fiberoptic nasotracheal intubation would result in fewer hemodynamic and catecholamine responses than when intubation was performed with a Macintosh laryngoscope. Blood samples were also taken to measure plasma catecholamine concentration immediately after intubation with the fiberscope. The mean ABP in the laryngoscope group was slightly greater than that of the fiberscope group for 4 min after intubation. Heart rates at 2 min and 4 min after intubation in the laryngoscope group were significantly greater than those for the fiberscope group. Even immediately after intubation, the mean plasma levels of epinephrine and norepinephrine were unchanged in the fiberscope group. Arterial oxygen saturation (Sp(O)(2)) was maintained within normal range during both of intubation procedures, although the time required for intubation was longer than in the laryngoscope group. Other cardiovascular complications were more common in the laryngoscope group than in the fiberscope group. These results suggest that fiberoptic intubation results in less severe stress than does laryngoscopic intubation. Fiberoptic intubation should therefore be used not only in patients with difficult airway, hypertension, ischemic heart disease, or cerebrovascular atherosclerosis, but also it is recommended for all patients for whom nasotracheal intubation is indicated.

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

“…Tsubaki et al . [2] found that following inhalational induction with 2% enflurane and 50% nitrous oxide, fibreoptic nasotracheal intubation resulted in less tachycardiac response and a similar pressor response compared with laryngoscopic nasotracheal intubation. The plasma concentrations of epinephrine and norepinephrine did not significantly change in the fibreoptic nasotracheal intubation group, but increased significantly in the laryngoscopic nasotracheal intubation group.…”

“…Tracheal intubation which is accomplished with a fibreoptic bronchoscope is thought to attenuate the circulatory responses to intubation as stimulation of oropharyngeal structures may be avoided. However, previous studies have provided inconsistent findings [1–4]. Smith et al .…”

“…Conversely, Tsubaki et al . [2] found that the fibreoptic nasotracheal intubation caused less severe circulatory and catecholamine responses than did laryngoscopic nasotracheal intubation. Staender et al .…”

The physiologic impact of transnasal flexible endoscopy

“…Typically performed in the office or bedside setting, TNFE provides the observer with a superior view of laryngeal function and pathology compared to indirect endoscopy with the laryngeal mirror. TNFE is practiced by physicians and allied health‐care providers from multiple disciplines, including anesthesiology, pediatric medicine, pulmonology, radiation oncology, and speech‐language pathology 2, 3. With the advent of distal chip technology, the improved resolution of vocal fold anatomy and pathophysiology has spurred the practice of office‐based interventional procedures.…”

“…Since TNFE has become common practice, few data have been collected on its safety outside of its use in nasotracheal intubation 2, 6. On the whole, this has led to the blind acceptance of TNFE as safe with minimal adverse side effects.…”