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      Evaluation of King's vision videolaryngoscope and glidescope on hemodynamic stress response to laryngoscopy and endotracheal intubation

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          Abstract

          Background and Aims:

          We hypothesis that the use of novel airway devices would decrease hemodynamic stress response (HDSR) to laryngoscopy and endotracheal (ET) intubation. The aim of our study was to evaluate the hemodynamic stress response (HDSR) to laryngoscopy and tracheal intubation using the King vision video laryngoscope (KVVL) versus glidescope (GLS).

          Material and Methods:

          A prospective randomized, comparative study that was conducted on 80 patients of both sexes; American Society of Anesthesiologists physical status I and II with no anticipated difficult airway, aged 20–60 years; who were scheduled for elective surgical procedure under general anesthesia. Patients were randomly allocated into two groups (40 each). Group I: laryngoscopy and tracheal intubation were carried out using KVVL, Group II: laryngoscopy and tracheal intubation were carried out using GLS. The two groups were compared for noninvasive hemodynamic data such as heart rate and mean arterial pressure. Time to successful intubation and number of attempts were recorded. Hemodynamic parameters were recorded at the preinduction, after induction, at intubation, 1 min, 3 min, 5 min, 10 min, and 15 min.

          Results:

          There was significant decrease ( P < 0.05) in HR and MBP in both groups just before intubation. In comparison with the baseline, HR and MBP in group I and group II increased but this difference was not significant at 3 min and 5 min after intubation and returned to the baseline at 10 min after intubation and below the baseline at 15 min after intubation. Also, there were no significant differences in the hemodynamic response between the studied groups.

          Conclusion:

          Novel airway devices either KVVL or GLS are efficient in reducing HDSR to laryngoscopy and ET intubation.

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          Most cited references15

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          Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement

          Background: Dexmedetomidine, an α-2 adrenoreceptor agonist, is gaining popularity for its sympatholytic, sedative, anaesthetic sparing and haemodynamic stabilising properties without significant respiratory depression. Methods: We assessed the efficacy of dexmedetomidine in attenuating sympathoadrenal response to tracheal intubation and analysed reduction in intraoperative anaesthetic requirement. Sixty patients scheduled for elective surgery of more than 3 hours were randomly selected. Control group received isoflurane–opioid and study group received isoflurane–opioid-dexmedetomidine anaesthesia. Dexmedetomidine infusion in a dose of 1 μg/kg was given over 10 min before the induction of anaesthesia and was continued in a dose of 0.2–0.7 μg/kg/Hr until skin closure. All patients were induced with thiopentone, fentanyl and vecuronium. Haemodynamic variables were continuously recorded. Results: The need for thiopentone and isoflurane was decreased by 30% and 32%, respectively, in the dexmedetomidine group as compared to the control group. After tracheal intubation, maximal average increase was 8% in systolic and 11% in diastolic blood pressure in dexmedetomidine group, as compared to 40% and 25%, respectively, in the control group. Similarly, average increase in heart rate was 7% and 21% in the dexmedetomidine and control groups, respectively. Fentanyl requirement during the operation was 100±10 μg in the control group and 60±10 μg in the dexmedetomidine group. Conclusion: Perioperative infusion of dexmedetomidine is effective in attenuating sympathoadrenal response to tracheal intubation. It has significant anaesthetic and opioid sparing effect.
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            Hemodynamic responses among three tracheal intubation devices in normotensive and hypertensive patients.

            We compare hemodynamic responses in normotensive and hypertensive anesthetized paralyzed patients among three intubation devices: the Macintosh laryngoscope (LS), the Trachlight lightwand (LW), and the intubating laryngeal mask airway Fastrach (ILM). Seventy-five normotensive and 75 hypertensive patients were randomly assigned to each intubation device (n = 25). Noninvasive systolic blood pressure (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were recorded immediately preinduction, immediately preintubation, and every minute for the first 5 min after the successful intubation. The number of intubation attempts, the time to successful intubation, and any airway injuries were recorded. Pharyngolaryngeal morbidity was assessed 18-24 h after surgery by a blinded investigator. In all groups, there was a reduction in SBP and DBP but no change in HR immediately preintubation compared with baseline values. In all groups, HR increased, but there were no increases in SBP and DBP other than in DBP in the LS/hypertensive group after intubation compared with baseline values. In normotensive patients, there were no differences in any hemodynamic variables among the three devices. In hypertensive patients, SBP and DBP in the LS group were significantly higher than the ILM and LW groups for 2 min after intubation, but there were no differences in HR among the devices. The number of intubation attempts was similar among groups, but intubation time was longer for the ILM group. The incidence of airway injury was more frequent for the ILM than the LS and LW groups (16% versus 0% versus 0%). There were no differences in pharyngolaryngeal morbidity among groups. We conclude that both the ILM and the LW attenuated the hemodynamic stress response to tracheal intubation compared with the LS in hypertensive, but not in normotensive, anesthetized paralyzed patients. Both the intubating laryngeal mask airway Fastrach and the Trachlight lightwand attenuate the hemodynamic stress response to tracheal intubation compared with the Macintosh laryngoscope in hypertensive, but not in normotensive, anesthetized paralyzed patients.
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              Force and pressure distribution using Macintosh and GlideScope laryngoscopes in normal and difficult airways: a manikin study.

              The forces applied to the soft tissues of the upper airway may have a deleterious effect. This study was designed to evaluate the performance of the GlideScope compared with the Macintosh laryngoscope. Twenty anaesthetists and 20 trainees attempted tracheal intubation of a Laerdal SimMan manikin. Forces and pressure distribution applied by both laryngoscope blades onto the soft upper airway tissues were measured using film pressure transducers. The minimal force needed to achieve a successful intubation, in the same simulated scenario, was measured; additionally, we considered the visualization score achieved by using the Cormack-Lehane grades. All participants applied, on average, lower force with the GlideScope than with the Macintosh in each simulated scenario. Forces [mean (sd)] applied in the normal airway scenario [anaesthetists: Macintosh 39 (22) N and GlideScope 27 (15) N; trainees: Macintosh 45 (24) N and GlideScope 21 (15) N] were lower than forces applied in the difficult airway scenario [anaesthetists: Macintosh 95 (22) N and GlideScope 66 (20) N; trainees: Macintosh 100 (38) N and GlideScope 48 (16) N]. All the intubations using the GlideScope were successful, regardless of the scenario and previous intubation experience. The average pressure on the blades was 0.13 MPa for the Macintosh and 0.07 MPa for the GlideScope, showing a higher uniformity for the latter. The GlideScope allowed the participants to obtain a successful intubation applying a lower force. A flatter and more uniform pressure distribution, a higher successful rate, and a better glottic view were observed with the GlideScope.
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                Author and article information

                Journal
                J Anaesthesiol Clin Pharmacol
                J Anaesthesiol Clin Pharmacol
                JOACP
                Journal of Anaesthesiology, Clinical Pharmacology
                Wolters Kluwer - Medknow (India )
                0970-9185
                2231-2730
                Apr-Jun 2020
                15 June 2020
                : 36
                : 2
                : 233-237
                Affiliations
                [1]Department of Anesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt
                Author notes
                Address for correspondence: Dr. Nagat S. EL-Shmaa, Department of Anesthesia, Surgical ICU and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt. E-mail: nagat_elshmaa@ 123456yahoo.com
                Article
                JOACP-36-233
                10.4103/joacp.JOACP_183_18
                7480299
                e529937a-bba0-40b6-8d49-a0ef522228f0
                Copyright: © 2020 Journal of Anaesthesiology Clinical Pharmacology

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 10 June 2018
                : 29 March 2019
                : 20 June 2019
                Categories
                Original Article

                Anesthesiology & Pain management
                endotracheal intubation,glidescope,hemodynamic stress response,the king vision video laryngoscope

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