TRACHEAL INTUBATION

DIRECT LARYNGOSCOPIC ORAL INTUBATION VS FIBEROPTIC BRONCHOSCOPIC NASAL INTUBATION HAEMODYNAMIC RESPONSE

Abstract

Introduction: Haemodynamic response to direct laryngoscopy and tracheal intubation has always been concern especially in cardiac patients. The use of fiberoptic bronchoscope for endotracheal tube placement may reduce the haemodynamic changes associated with intubation. Objectives: To compare haemodynamic changes (pulse and mean arterial pressure) following tracheal intubation, using direct laryngoscopic technique with fiberoptic bronchoscopic technique. Study Design: Randomized Controlled Trial (RCT). Settings and Duration: Department of Anaesthesiology, Intensive Care and Pain management Military hospital Rawalpindi. The study was of six months duration starting from April 2008 to October 2008. Subject and Methods: ASA-I and II patients (n=160) undergoing surgery meeting the inclusion and exclusion criteria.Informed consent was taken from all the patients undergoing the study. Patients were divided in two groups. Patients assigned to Group A got endotracheal intubation through direct laryngoscopic technique and Group B through fiberoptic bronchoscopic technique after induction of general anaesthesia. Pulse and Mean arterial pressure were recorded before induction of anaesthesia and three minutes after the intubation. Results: One hundred and sixty patients were studied. Eighty patients intubated through direct laryngoscopy (Group A) and eighty patients intubated through fiberoptic bronchoscope and it was observed that fiberoptic bronchoscopic intubation is haemodynamically safer as compared to conventional laryngoscopic intubation. Conclusion: The study concluded that bronchoscopic intubation provides better haemodynamic stability than direct laryngoscopic intubation.