Studies of Anaesthesia in Relation to Hypertension Ii: Haemodynamic Consequences of Induction and Endotracheal Intubation

Use of the fibreoptic stylet scope (Styletscope™) reduces the hemodynamic response to intubation in normotensive and hypertensive patients

“…These procedures are associated with hemodynamic changes. [1][2][3] One of the reasons for the smaller hemodynamic changes following tracheal intubation using a stylet scope was, probably, less stimulus to the perilaryngeal area. Similar investigations using a lightwand (Trachlight™, Laerdal Medical, Armonk, NY, USA) technique have been conducted, 9,10 since this method of intubation requires neither elevation of the epiglottis by the laryngoscope blade nor exposure of the glottic opening.…”

“…Tracheal intubation using this technique is, however, often associated with an increase in blood pressure and heart rate, 1,2 which may be severe in hypertensive patients. 3 These changes greatly increase the risk of myocardial infarction or stroke, especially in elderly patients with hypertension. [4][5][6] Kitamura et al 7,8 have recently described a new fibreoptic stylet scope (Styletscope™; Nihon Kohden, Tokyo, Japan, Figure 1A), for tracheal intubation.…”

Lightwand intubation is associated with less hemodynamic changes than fibreoptic intubation in normotensive, but not in hypertensive patients over the age of 60

“…1 Elderly patients also have a higher incidence of hypertension compared with young and middle-aged patients, and hypertensive patients are prone to greater circulatory responses after tracheal intubation than are normotensive patients. 2 Thus, the maintenance of hemodynamic stability during tracheal intubation is of particular clinical importance in elderly patients with hypertension.…”

“…Transient hypertension and tachycardia associated with laryngoscopy and endotracheal intubation are probably of little consequence in young healthy patients, but either or both may be hazardous to elderly patients, 1 especially to those with hypertension or myocardial insufficiency. 2 Therefore, reduction of hemodynamic responses during tracheal intubation is of particular clinical importance in elderly patients with hypertension.…”

Preoperative beta-blockade for patients undergoing craniotomy: a comparison between propranolol and atenolol

“…In certain situations this may be deleterious to the patient, including those patients with compromised left ventricular function or ischaemic heart disease. 5 Patients with cerebral pathology may also be at risk from pressor responses during laryngoscopy and tracheal intubation. Burney and Winn 4 demonstrated an increase in intracranial pressure in response to laryngoscopy and tracheal intubation in 14 patients undergoing craniotomy or carotid angiography using a similar induction sequence to that used in this study.…”