Evaluation of the cardiovascular responses to fiberoptic orotracheal intubation with television monitoring: Comparison with conventional direct laryngoscopy

Study Objective: To evaluate and compare cardiovascular responses to a new method of orotracheal intubation incorporating TV monitoring, with conventi onal orotracheal intubation via rigid blade laryngoscopy. Design: Prospective single-blind study. Setting: Operating room of a medical college hospital. Patients: 90 ASA physical status I and II surgical patients requiring gener al anesthesia and orotracheal intubation. Interventions: Patients were randomly allocated to two groups, one for the new intubation method and the other for conventional intubation using a rig id laryngoscope. In the new method, an anesthesiologist inserted an endotra cheal tube alone into the trachea via TV monitoring through the bronchoscop e, which was inserted by an assistant through the mouth to the middle laryn x. The patient's trachea was intubated without extreme stretching of laryng eal tissues or deep insertion of the tip of the bronchoscope. In the conven tional method, orotracheal intubation was performed with rigid direct laryn goscopy. Measurements: Noninvasive blood pressure (BP) and heart rate (HR) were meas ured before arrival at the operating room, and before and after orotracheal intubation. Main Results: Although this method was expected to be a minimally invasive fiberoptic intubation technique, the patients showed significant increases in BP and HR. No significant differences between the two groups were observ ed in cardiovascular responses immediately after intubation: the systolic B P, 169.5 +/- 28.3 versus 167.0 +/- 23.1 mmHg, and HR, 100.2 +/- 18.2 versus 98.8 +/- 16.6 bpm. Conclusions: Insertion of an endotracheal tube may itself be the most invas ive stimulus during intubation procedures. (C) 2000 by Elsevier Science Inc .