Comparison of Hemodynamic Changes by Using the Videolaryngoscope and the Macintosh Laryngoscope

Comparison of Hemodynamic Changes After Endotracheal Intubation by Using the Videolaryngoscope and the Macintosh Direct Laryngoscope in Elderly Hypertensive Patients

Tracheal intubation techniques that avoid or minimize pharyngolaryngeal stimulation might attenuate the hemodynamic stress response. Tracheal intubation using video laryngoscope needs comparatively less airway manipulation so, the investigators expect less hemodynamic response while using videolaryngoscope.

The hemodynamic stress response to tracheal intubation can precipitate adverse cardiovascular events in patients with cardiovascular disease. Which is shown to greatly increase the risk of myocardial infarction or stroke, especially in elderly patients with hypertension. Direct laryngoscopy and laryngoscopic stimulation of pharyngolaryngeal structures may be an important factor in the hemodynamic stress response associated with tracheal intubation.

Patients were randomly allocated to two groups using a permuted block randomization method: 1) patients intubated by using the videolaryngoscopy 2) patients intubated by using the Macintosh laryngoscope . SAP, MAP, and heart rate were measured and recorded in the operating room: At baseline, before intubation, immediately after intubation and 1,2,3,4 and 5 minutes after tracheal intubation.

Inclusion Criteria:

• American Society of Anesthesiologists Physical Status II-III,
• aged over 65 years,
• controlled hypertensive patients,
• scheduled for elective coronary artery bypass grafting.

Exclusion Criteria:

• American Society of Anesthesiologists Physical Status IV,
• ejection fraction < 40%,
• any anatomical abnormality in head, neck or face,
• Mallampati score of IV,
• history of difficult intubation or laryngoscopy