Cardiovascular Changes During Awake Rigid and Fiberoptic Laryngoscopy

Awake Fibreoptic Intubation in the Patient at High Risk of Aspiration

“…The primary advantages of fibreoptic intubation are its undoubted value in the management of a known or potential difficult tracheal intubation [15][16][17], and the lesser degree of hypertension and tachycardia that accompany it [19,20]. Its initial use in our practice for patients at high risk of aspiration was for those patients who also presented a potentially difficult intubation.…”

“…It has three additional significant advantages over the rapid sequence induction and intubation technique: it is not subject to the three hazards of failure of cricoid pressure to prevent regurgitation and aspiration [12,21], failure to intubate the trachea of such a patient [6,10,11], and cardiovascular collapse [10]. It has two advantages over awake rigid intubation in that it is less painful and unpleasant for the patient [2,7,8,[16][17][18], and it may have a higher success rate [20]. However, it has the disadvantage, compared with the rapid sequence induction and intubation technique, of recall of the intubation in many instances [17,18].…”

“…success if the intubation proves to be difficult [15][16][17], and minimizes the trauma and discomfort [16][17][18], and cardiovascular responses [19][20] associated with rigid laryngoscopy. In addition, awake fibreoptic laryngoscopy also appears to have a higher success rate than awake rigid laryngoscopy, even in patients who are not judged to present potentially difficult intubation [20]. As there do not appear to be any carefully documented reports describing the use of this technique for such patients, this descriptive report summarizes our experience with 129 awake fibreoptic tracheal intubations in 121 patients considered to be at high risk of aspiration of gastric contents.…”

Reflex circulatory responses after three stages of nasotracheal intubation and two stages of orotracheal intubation: A comparative study

“…Consequently, there is evidence that the magnitude of the pressor response varies with the intubation techniques. 16,17,18,19 In this study, we have divided nasotracheal intubation into three distinct stages namely -nasopharyngeal intubation, direct laryngoscopy, tracheal intubation and orotracheal intubation into two stages -direct laryngoscopy and tracheal intubation with the objective to identify the haemodynamic changes that occur during each stage of intubation through oral and nasal routes. We have used conventional laryngoscope and endotracheal tube wherever applicable.…”