Comparison of Haemodynamic Responses between Clinical AssessmentGuided Tracheal Intubation and Neuromuscular Block Monitoring-Guided Tracheal Intubation
Authors/Creators
- 1. Senior Resident, Department of Anaesthesia, Sri Siddhartha Institute of Medical Sciences and Research Centre, T. Begur, Nelamangala, Bangalore, Karnataka, India
- 2. Assistant professor, Department of Anaesthesia, Sri Siddhartha Institute of Medical Sciences and Research Centre, T. Begur, Nelamangala, Bangalore, Karnataka, India
- 3. Post Graduate, Department of Anaesthesia, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
- 4. Professor, Department of Anaesthesia, Sri Siddhartha Institute of Medical Sciences and Research Centre, T. Begur, Nelamangala, Bangalore, Karnataka, India
Description
Introduction: Endotracheal intubation is the commonest procedure done during general anaesthesia and it includes stressor response during the procedure. It is a challenging task to do it with minimal stress response. The purpose of our study was to find a better technique to assess the adequate intubating condition to reduce the stress response of endotracheal intubating procedure and hence we compared clinical assessment guided tracheal intubation and train of four (TOF) guided tracheal intubation and looked for the haemodynamic responses. Aim: To assess the haemodynamic responses of tracheal intubation guided via Train of Four (TOF) monitoring compared to tracheal intubation guided via clinical assessment. Method: In this prospective randomized clinical study, 70 adults, ASA -1 and ASA-2, MPG- 1 and MPG-2 undergoing elective surgery under general anaesthesia with tracheal intubation were allocated to two groups (n = 35) according to TOF guided (Group T) or Clinical assessment guided (Group C) tracheal intubation. Anaesthesia was induced with Inj.propofol 2mg/kg and after standardization of supramaximal stimulus, Inj.Vecuronium 0.1mg/kg was administered. In group T, trachea was intubated after TOF ratio became zero in Adductor Pollicis muscle, whereas in group C, trachea was intubated after clinical assessment of jaw muscle relaxation, airway tone and ease of ventilation. Changes in heart rate, mean arterial pressure, mean systolic blood pressure, mean diastolic blood pressure were recorded along with intubating conditions which were scored on a Kreig et al score. Results were analysed by Paired-t test and chi square test. Results: Heart rate, mean arterial pressure, mean systolic blood pressure and mean diastolic blood pressure were observed to be significantly higher in Group C compared to Group T (P<0.05). Excellent and good intubating conditions were found in both the groups. However, 91.43% excellent intubating conditions were found in Group T compared to 57.14% in Group C. Conclusion: Neuromuscular block monitoring of Adductor Pollicis muscle based endotracheal intubation can be a suitable, non-pharmacological method in assessing appropriate time of intubation, providing excellent intubating conditions hence significant attenuation of hemodynamic response to laryngoscopy and tracheal intubation.
Abstract (English)
Introduction: Endotracheal intubation is the commonest procedure done during general anaesthesia and it includes stressor response during the procedure. It is a challenging task to do it with minimal stress response. The purpose of our study was to find a better technique to assess the adequate intubating condition to reduce the stress response of endotracheal intubating procedure and hence we compared clinical assessment guided tracheal intubation and train of four (TOF) guided tracheal intubation and looked for the haemodynamic responses. Aim: To assess the haemodynamic responses of tracheal intubation guided via Train of Four (TOF) monitoring compared to tracheal intubation guided via clinical assessment. Method: In this prospective randomized clinical study, 70 adults, ASA -1 and ASA-2, MPG- 1 and MPG-2 undergoing elective surgery under general anaesthesia with tracheal intubation were allocated to two groups (n = 35) according to TOF guided (Group T) or Clinical assessment guided (Group C) tracheal intubation. Anaesthesia was induced with Inj.propofol 2mg/kg and after standardization of supramaximal stimulus, Inj.Vecuronium 0.1mg/kg was administered. In group T, trachea was intubated after TOF ratio became zero in Adductor Pollicis muscle, whereas in group C, trachea was intubated after clinical assessment of jaw muscle relaxation, airway tone and ease of ventilation. Changes in heart rate, mean arterial pressure, mean systolic blood pressure, mean diastolic blood pressure were recorded along with intubating conditions which were scored on a Kreig et al score. Results were analysed by Paired-t test and chi square test. Results: Heart rate, mean arterial pressure, mean systolic blood pressure and mean diastolic blood pressure were observed to be significantly higher in Group C compared to Group T (P<0.05). Excellent and good intubating conditions were found in both the groups. However, 91.43% excellent intubating conditions were found in Group T compared to 57.14% in Group C. Conclusion: Neuromuscular block monitoring of Adductor Pollicis muscle based endotracheal intubation can be a suitable, non-pharmacological method in assessing appropriate time of intubation, providing excellent intubating conditions hence significant attenuation of hemodynamic response to laryngoscopy and tracheal intubation.
Files
IJTPR,Vol13,Issue7,Article24.pdf
Files
(436.2 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:55969c6da99d10068b511b6d7ca42098
|
436.2 kB | Preview Download |
Additional details
Dates
- Accepted
-
2023-05-25
Software
References
- 1. P.F Kotur. Decision Making in Airway Management. Indian Journal of Anaesthesia 2005;49(4):248-50. 2. Jayashree Sood. Laryngeal mask airway and its variants. Indian Journal of Anaesthesia 2005;49(4):275-80. 3. Kazama T, Ikeda K. Reduction by fentanyl of the Cp50 values of propofol and haemodynamic responses to various noxious stimuli. Anesthesiology. 1997; 87:213-27. 4. Kovac A L.Controlling the haemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth1996; 8:63-79. 5. Angelard B, Debry C, Planquart X, Dubos D, Dominic L, Gondret R, et al. Difficultintubations. A prospective study. Ann Otolaryngol Chir Cervicofac. 1991; 108(4):241-3. 6. Morgan JM, Barker I, Peacock JE, Eissa A. A comparison of intubating conditions in children following induction of anaesthesia with propofol and suxamethonium or propofol and remifentanil Anaesthesia. 2007; 62:135-9. 7. Rundshagen I, Schröder T, Prichep LS, John ER, Kox WJ. Changes in corticalelectrical activity during induction of anaesthesia with thiopental/fentanyl and tracheal intubation: A quantitative electroencephalographic analysis. Br J Anaesth. 2004; 92:33-8. 8. Smith I, Saad Rs. Comparison of intubating conditions after rocuronium or vecuronium when the timing of intubation is judged by clinical criteria. Br J Anaesth 1998; 80:235-7. 9. Debaene B, Beaussier M, Meistelman C, Donati F, Lienhart A. Monitoring the onset of neuromuscular block at the orbicularis oculi can predict good intubating conditions during atracurium-induced neuromuscular block. Anesth Analg. 1995; 80:360-3. 10. Witkowska M, Karwacki Z, Wierzchowska J, Bukowski P. Neuromuscular block monitoring for optimization of conditions for endotracheal intubation. Anestezjol Intens Ter 2009; 41:140-4. 11. Le Corre F, Plaud B, Benhamou E, Debaene B. Visual estimation of onset time atthe Orbicularis Oculi after five muscle relaxants: application to clinical monitoring of tracheal intubation. Anesth Anal 1999; 89: 1305-10. 12. Nandi R., Basu S.R., Sarkar S., & Garg R. A comparison of haemodynamic responses between clinical assessment-guided tracheal intubation and neuromuscular block monitoringguided tracheal intubation: A prospective, randomised study. Indian Journal of Anaesthesia 2017., 61, 910 - 915. 13. Jankovic R., Stojanovic M.D., Marković D.Z., Cvetanović V., Vukovic A.Z., Nikolić A., Veselinović I., & Stosic B. Impact of Different Stimulation Patterns of Neuromuscular Blockade Monitoring and Clinical Assessment on Intubation Time and Intensity of Hemodynamic Response During Rocuronium Induced Endotracheal Intubation. Signa Vitae 2020.