Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.07.017
Brazilian Journal of Anesthesiology
Original Investigation

Comparison of hemodynamic response to tracheal intubation with two different videolaryngoscopes: A randomized clinical trial

Comparação da resposta hemodinâmica à intubação traqueal com dois videolaringoscópios diferentes: ensaio clínico randomizado

Tülay Çardaközü; Z. ̇Ipek Arslan; Sevim Cesur; Barış Aksu

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Abstract

Background
Endotracheal intubation (ETI), which is the gold standard in coronary artery bypass grafting (CABG), may cause myocardial ischaemia by disturbing the balance between haemodynamic changes and oxygen supply and consumption of the myocardium as a result of sympathetic stimulation. In this study, we aimed to compare two different videolaryngoscopes (C-MAC and Airtraq) in the hemodynamic response to ETI.

Methods
Fifty ASA II–III CABG surgery patients were randomly assigned to C-MAC or Airtraq. The hemodynamic data included arterial blood pressure [systolic (SAP), diastolic (DAP) and mean (MAP)] and heart rate (HR) and were recorded at six different points in time: before laryngoscopy-T1, during laryngoscopy-T2, immediately after intubation-T3, and 3 (T4), 5 (T5) and 10 (T6) minutes after intubation. Intraoperative complications were recorded. Patients were questioned about postoperative complications 2 and 24 hours following extubation.

Results
The hemodynamic response to ETI was significantly greater with C-MAC. The increase in HR started with the laryngoscopy procedure, whereas increases in SAP, DAP, and MAP started immediately after ETI (p = 0.024; p = 0.012; p = 0.030; p = 0.009, respectively). In group analyses, T1–T2, T2–T3 and T1–T3 comparisons did not show any significant differences in HR with Airtraq. However, with C-MAC, HR after intubation increased significantly compared to the pre-laryngoscopy values (T1–T3) (p = 0.004). The duration of laryngoscopy was significantly reduced with C-MAC (p < 0.001), but the duration of intubation and total intubation were similar (p = 0.36; p = 0.79).

Conclusions
Compared to C-MAC, the hemodynamic response to ETI was less with Airtraq. Thus, Airtraq may be preferred in CABG patients for ETI.

Keywords

Coronary artery bypass grafting surgery;  Airtraq;  C-MAC;  Videolaryngoscopy;  Hemodynamic response;  Intubation

Resumo

Introdução

A intubação endotraqueal (IET), que é o padrão-ouro na cirurgia de revascularização miocárdica (CRM), pode causar isquemia miocárdica por perturbar o equilíbrio entre as alterações hemodinâmicas e a oferta e consumo de oxigênio do miocárdio como resultado da estimulação simpática. Neste estudo, nosso objetivo foi comparar dois videolaringoscópios diferentes (C-MAC e Airtraq) na resposta hemodinâmica à IET.

Métodos

Cinquenta pacientes ASA II-III CABG cirurgia foram aleatoriamente designados para C-MAC ou Airtraq. Os dados hemodinâmicos incluíram pressão arterial [sistólica (PAS), diastólica (DAP) e média (PAM)] e frequência cardíaca (FC) e foram registrados em seis momentos diferentes: antes da laringoscopia (T1), durante a laringoscopia (T2). , imediatamente após a intubação (T3), e 3 (T4), 5 (T5) e 10 (T6) minutos após a intubação. Complicações intraoperatórias foram registradas. Os pacientes foram questionados sobre complicações pós-operatórias 2 e 24 horas após a extubação.

Resultados

A resposta hemodinâmica à IET foi significativamente maior com o C-MAC. O aumento da FC começou com o procedimento de laringoscopia, enquanto os aumentos do SAP, DAP e MAP começaram imediatamente após a IET (p = 0,024; p = 0,012; p = 0,030; p = 0,009, respectivamente). Nas análises de grupo, as comparações T1-T2, T2-T3 e T1-T3 não mostraram diferenças significativas na FC com Airtraq. Porém, com C-MAC, a FC após intubação aumentou significativamente em comparação aos valores pré-laringoscopia (T1–T3) (p = 0,004). A duração da laringoscopia foi significativamente reduzida com C-MAC (p < 0,001), mas a duração da intubação e intubação total foram semelhantes (p = 0,36; p = 0,79).

Conclusão

Comparado ao C-MAC, a resposta hemodinâmica à IET foi menor com o Airtraq. Assim, Airtraq pode ser preferido em pacientes de CABG para IET.

Palavras-chave

Cirurgia de revascularização do miocárdio; Airtraq; C-MAC; Videolaringoscopia; Resposta hemodinâmica; intubação

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