Comparing Hemodynamic Responses to Intubation in Hypertensive Patients: Clearvue® Video Laryngoscope Versus Macintosh Direct Laryngoscope
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Introduction: The ClearVue® video-laryngoscope (CVL) is believed to alleviate the stress response associated with intubation by providing superior laryngeal views, minimizing oropharyngo-laryngeal stimulation, and potentially reducing the pressor response.
Objective: This study aims to assess and compare how effective and safe intubation is when using a CVL versus a Macintosh direct laryngoscope (MDL) in patients with high blood pressure who are having surgery.
Methods: This prospective, randomized, interventional study was conducted on 140 hypertensive patients on antihypertensive medication undergoing elective surgery under general anesthesia (GA), who were allocated into two groups, CVL group (n = 70) and MDL group (n = 70). Hemodynamic parameters, including mean arterial pressure (MAP), mean heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP), were monitored at baseline, induction, and at various intervals post-intubation (1, 2, 3, 4, 5, and 10 minutes). Other metrics, such as intubation time, intubation attempts, ease of intubation, and associated complications, were documented.
Results: Significant differences in heart rate were observed between the groups, right at intubation and at 1, 2, and 3 minutes post-intubation (p-values: 0.011; 0.028; 0.002; 0.003). SBP showed significant differences at intubation and during the first four minutes post-intubation (p-values < 0.001 except for the fourth minute, p = 0.001). DBP and MBP also showed significant differences at various intervals post-intubation (p-values < 0.001 to 0.025 and < 0.001 to 0.020, respectively). No significant difference in airway complications was noted.
Conclusion: The CVL offers advantages over MDL in patients with controlled hypertension, specifically in reducing hemodynamic changes during intubation without increasing airway complications. At the same time, MDL offered less intubation time overall than CVL.
Aggarwal H, Kaur S, Baghla N, Kaur S. Hemodynamic Response to Orotracheal Intubation: Comparison between Macintosh, McCoy, and C-MAC Video Laryngoscope. Anesth Essays Res. 2019; 13(2): 308–12.
Padavarahalli Thammanna P, Marasandra Seetharam K, Channasandra Anandaswamy T, Rath P, Chamanhalli Rajappa G, Joseph J. Comparison of Haemodynamic Response to Intubation with KingVision and C-MAC Videolaryngoscope in Adults. Archives of Anesthesia and Critical Care. 2020; 6(2): 65-70.
Bheemanna Nalini K, Gopal A, Shankar Iyer S, Mungasuvalli Chanappa N. A Comparative Crossover Randomized Study of Miller and Macintosh Blade for Laryngoscopic View and Ease of Intubating Conditions in Adults. Archives of Anesthesia and Critical Care. 2021; 7(2): 58-62.
Kikura M, Suzuki K, Itagaki T, Takada T, Sato S. Age and comorbidity as risk factors for vocal cord paralysis associated with tracheal intubation. Br J Anaesth. 2007; 98(4): 524–30.
Meshram TM, Ramachandran R, Trikha A, Rewari V. Haemodynamic responses following orotracheal intubation in patients with hypertension---Macintosh direct laryngoscope versus Glidescope®videolaryngoscope. Indian J Anaesth. 2021; 65(4): 321–7.
Pournajafian AR, Ghodraty MR, Faiz SHR, Rahimzadeh P, Goodarzynejad H, Dogmehchi E. Comparing GlideScope Video Laryngoscope and Macintosh Laryngoscope Regarding Hemodynamic Responses During Orotracheal Intubation: A Randomized Controlled Trial. Iran Red Crescent Med J. 2014; 16(4): e12334.
Bucx MJ, Scheck PA, Van Geel RT, Den Ouden AH, Niesing R. Measurement of forces during laryngoscopy. Anaesthesia. 1992; 47(4): 348–51.
Jain P. Comparison of Hemodynamic Response in Direct and Video Laryngoscopy in Hypertensive Patients. Indian Journal of Anesthesia and Analgesia. 2020; 7(4): 879–87.
Cecchini S, Silvestri S, Carassiti M, Agro FE. Static forces variation and pressure distribution in laryngoscopy performed by straight and curved blades. Annu Int Conf IEEE Eng Med Biol Soc. 2009; 2009: 865–8.
Carassiti M, Zanzonico R, Cecchini S, Silvestri S, Cataldo R, Agrò FE. Force and pressure distribution using Macintosh and GlideScope laryngoscopes in normal and difficult airways: a manikin study. Br J Anaesth. 2012; 108(1): 146–51.
Kill C, Risse J, Wallot P, Seidl P, Steinfeldt T, Wulf H. Videolaryngoscopy with glidescope reduces cervical spine movement in patients with unsecured cervical spine. J Emerg Med. 2013; 44(4): 750–6.
Turkstra TP, Craen RA, Pelz DM, Gelb AW. Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope. Anesth Analg. 2005; 101(3): 910–5.
Li XY, Xue FS, Sun L, Xu YC, Liu Y, Zhang GH, et al. Comparison of hemodynamic responses to nasotracheal intubations with Glide Scope video-laryngoscope, Macintosh direct laryngoscope, and fiberoptic bronchoscope. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2007; 29(1): 117–23.
Phil Tsai, BiingJaw Chen. Hemodynamic Responses to Endotracheal Intubation Comparing the Airway Scope®, Glidescope®, And Macintosh Laryngoscopes P Tsai, B Chen. The Internet Journal of Anesthesiology. 2009; 24(2): 1–6.
Samal RL, Swain S, Samal S. A Comparative Study between Truview PCD Video Laryngoscope and Macintosh Laryngoscope with Respect to Intubation Quality and Hemodynamic Changes. Anesth Essays Res. 2021; 15(1): 73–80.
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