全麻诱导气管插管时大脑皮层电活动与血流动力学的变化——比较异丙酚和硫喷妥钠的药理作用

目的：探讨数量化脑电图在反映麻醉诱导气管插管期间脑电的活动程度，以及ＥＥＧ和心血管反应相关性研究。方法：７０例ＡＳＡⅠ级病人，随机双盲分两组，组Ⅰ（ｎ＝３５）硫喷妥钠，组Ⅱ（ｎ＝３５）异丙酚。硫喷妥钠或异丙酚和琥珀胆碱行气管插管。分别于诱导前、诱导后、气管插管后１～２分和３～５分监测数量化脑电图、ＭＡＰ、ＨＲ、ＳｐＯ２的变化。结果：诱导前，两组病人的ＥＥＧ及血流动力学参数无差异。诱导后，ＥＥＧ抑制，ＳＥＦ、ＭＦ、ＢＩＳ下降，δＲ升高，但两组之间无区别；异丙酚组ＭＡＰ降低程度大于硫喷妥钠组（Ｐ＜０．０１），ＨＲ无差异。气管插管后，ＥＥＧ活化，ＳＥＦ、ＭＦ、ＢＩＳ升高（Ｐ＜０．０１），δＲ降低（Ｐ＜０．０１），异丙酚组ＥＥＧ各参数的变化程度轻于硫喷妥钠组（Ｐ＜０．０１）；异丙酚组ＭＡＰ和ＨＲ升高程度小于硫喷妥钠组（Ｐ＜０．０１）。结论：气管插管前，等效剂量的异丙酚和硫喷妥钠对中枢神经的抑制程度类似，气管插管后，异丙酚组的ＥＥＧ活化程度及血流动力学的变化明显轻于硫喷妥钠。     

异丙酚、硫喷妥钠预防气管插管危险性的临床随机对照研究

目的 比较异丙酚与硫喷妥钠预防拨管插的危险性的效果。方法 选择全麻气管插管手术病人２２４例，观察异丙酚２．０ｍｇ／ｋｇ复合芬太尼２μｇ／ｋｇ的气管插管危险性，并采用多因素分析与硫喷妥钠５．０ｍｇ／ｋｇ复合芬太尼２μｇ／ｋｇ进行比较。结果 硫喷妥钠组不率为８５．５９％，异丙酚组为８１．４２％，组间无显著性差异（Ｐ〉０．０５），除外低血压症，硫喷妥钠组不满意率为７９．２８％，异丙酚分别为４５．１３％，     

异丙酚麻醉诱导期间不同剂量瑞芬太尼对病人气管插管心血管反应的影响

目的比较异丙酚麻醉诱导期间不同剂量瑞芬太尼对病人气管插管心血管反应的影响，寻找瑞芬太尼复合异丙酚气管插管的合适剂量。方法择期行腹腔镜胆囊切除术病人36例，ASAⅠ或Ⅱ级，年龄20～65岁，随机分为3组（n=12）：瑞芬太尼1、1．5、2μg／kg分别为复合异丙酚1．5μg／kg组（Ⅰ、Ⅱ、Ⅲ组）。依次静脉注射咪唑安定0．03mg／kg、异丙酚1．5mg/kg、维库溴铵0．1mg／kg以及瑞芬太尼麻醉诱导，2min后气管插管，进行机械通气，呼吸频率12次／min，潮气量8～10ml／kg，维持呼气末二氧化碳分压35～45mmHg。持续监测血压（平均动脉压、舒张压、收缩压）、心率（HR）以及听觉诱发电位指数（AAI），并记录病人有无气管插管时呛咳和肌肉强直、术中知晓等反应。结果与基础值比较，三组气管插管前即刻血压及Ⅲ组气管插管后即刻舒张压均降低，Ⅲ组气管插管后即刻血压低于Ⅰ组（P〈0．05）；HR组间及组内比较差异无统计学意义；三组间AAI差异无统计学意义。结论异丙酚1．5mg／kg麻醉诱导期间瑞芬太尼1或1．5μg／kg是病人气管插管时的合适剂量。     

Bonfils纤维喉镜用于困难气道病人插管的效果

目的 评价Bonfils纤维喉镜用于困难气道病人插管的效果。方法 择期行全麻气管插管手术病人18例，术前气道评估（Mallampati评级≥Ⅲ级，甲颏距离〈6cm，或不足3横指，张口度〈3．5cm）符合以上任何一项者或有颈部活动受限，颈椎不稳定者和肢端肥大的病人纳入本研究。常规麻醉诱导后用Bonfils纤维喉镜插管。记录诱导前、插管前、插管后的血压和心率。按喉镜插入口咽腔、看见会厌、进入声门和置入气管导管的难易度评估插管情况，记录插管时间和失败率，并随访插管后的不良反应。结果插管后收缩压和心率较插管前均有一定程度的增加，但波动均在正常生理范围内。所有病人均一次插管成功，平均插管时间为62s，有4例（22％）病人看见会厌的难易度为一般，1例（5．6％）病人进入声门较困难。除1例病人外其余的病人术后均无明显咽喉疼痛、声音嘶哑等不良反应。结论Bonfils纤维喉镜对于潜在的困难气道的病人是一种简便易行的插管装置。     

不同剂量右美托咪定对丙泊酚诱导效应室靶浓度的影响

目的观察不同剂量右美托咪定在全麻患者气管插管时有效性和安全性及对丙泊酚效应室靶浓度(Ce)的影响。方法 60例全麻下行择期上腹部手术患者,随机均分为四组:D1、D2、D3、C组,分别在麻醉诱导前10min静脉泵注右美托咪定0.25μg/kg(D1组)、0.5μg/kg(D2组)和1.0μg/kg(D3组)及10ml生理盐水(C组)。麻醉诱导采用靶控输注丙泊酚,以BIS为靶控目标。丙泊酚初始Ce设为1.5μg/ml,递增梯度为0.5μg/ml,同时泵注瑞芬太尼0.2μg·kg-1·min-1。BIS≤60时推注罗库溴铵0.9mg/kg,BIS≤50并维持5s行气管插管。于输注右美托咪定前(T0)、诱导前(T1)、气管插管前(T2)、气管插管后1min(T3)、3min(T4)、5min(T5)、10min(T6)时记录SBP、DBP、HR、BIS、丙泊酚Ce。结果与T0时比较,T1时D2、D3组HR减慢、D3组SBP、DBP升高(P<0.05);与T1时比较,T2时D1组和C组SBP、DBP下降,HR减慢(P<0.05);与T2时比较,T3～T5时D1组和C组SBP、DBP升高,HR增快,T3时C组BIS升高(P<0.05)。T2～T6时丙泊酚CeD1、D2、D3组明显低于C组(P<0.05)。不同剂量右美托咪定各时点对丙泊酚Ce存在明显负相关关系。结论麻醉诱导前静脉输注不同剂量右美托咪定对丙泊酚诱导效应室浓度存在负相关关系。麻醉诱导前静脉输注右美托咪定0.5μg/kg心血管反应平稳并能显著减少诱导时所需丙泊酚Ce。     

丙泊酚靶控输注时羟考酮抑制气管插管反应的半数有效剂量

目的测定丙泊酚靶控输注时羟考酮抑制气管插管反应的半数有效剂量(ED_(50))。方法择期全麻下手术的患者,性别不限,年龄18~65岁,BMI 18.5~24.9kg/m~2,ASAⅠ或Ⅱ级,MallampatiⅠ或Ⅱ级。静脉顺序注射羟考酮、靶控输注丙泊酚血浆浓度4μg/ml,BIS60时,静注罗库溴铵0.9mg/kg后行气管插管机械通气。采用改良Dixon序贯法进行试验,羟考酮起始剂量0.2mg/kg。若气管插管反应阳性,则下一例增加剂量;反之,则降低剂量,相邻剂量比值为1∶1.1。气管插管反应阳性的标准:插管后2min内MAPmax或HRmax较基础值≥20%。采用加权概率法计算羟考酮抑制气管插管反应的ED_(50)、ED_(95)及其相应的95%可信区间(CI)。结果共有27例患者完成正式研究。羟考酮抑制气管插管反应的ED_(50)为0.204 mg/kg,(95%CI 0.175~0.249 mg/kg),ED_(95)为0.342mg/kg(95%CI 0.287~0.409mg/kg)。结论血浆靶控输注丙泊酚4μg/ml时,羟考酮抑制气管插管反应的ED_(50)为0.204mg/kg,ED_(95)为0.342mg/kg。     

异丙酚诱导插管对血浆降钙素基因相关肽及内皮素水平的影响

目的 探讨异丙酚诱导插管对血浆ＣＧＲＰ含量的影响。方法 择期手术病人３６例,ＡＳＡⅠ～Ⅱ级,随机分为异丙酚（ＰＰ组,２０例）硫喷妥钠（ＳＰ组,１６例）两组,分别于麻醉前、用药后、插管后２ｍｉｎ、７ｍｉｎ、１５ｍｉｎ测定血浆中ＣＧＲＰ、ＥＴ的含理及血液动力学变化。结果 两组给药后血压均下降,插管后硫喷妥钠组血压迅速上升,异丙酚组插管后ＣＧＲＰ、ＥＴ含量略有下降,但无统计学意义（Ｐ〉０．０５）。硫喷妥     

右美托咪定同时靶控输注丙泊酚用于慢诱导纤维支气管镜引导经鼻气管内插管术的临床观察

目的 观察右美托咪定(dexmedetomidine,Dex)同时靶控输注(target controlled infusion,TCI)丙泊酚用于慢诱导纤维支气管镜(fiberoptic bronchoscopy,FOB)引导经鼻气管内插管术的可行性和安全性. 方法 拟行全身麻醉下颌面部肿瘤切除术的患者143例,年龄18～65岁,BMI 18～30 kg/m2,ASA分级Ⅰ、Ⅱ级,完全随机分为丙泊酚TCI组(P组,65例)和Dex组(D组,78例).入室后两组均静脉注射芬太尼1.5 μg/kg,TCI丙泊酚,丙泊酚初始血浆靶浓度(plasma concentration,Cp)为1.0 mg/L.D组同时负荷输注Dex(0.5μg/kg,10 min).根据BIS调整丙泊酚Cp.BIS值降至85时环甲膜穿刺注射2％丁卡因2.5 ml,1％丁卡因2ml行鼻腔黏膜表面麻醉.BIS值降至80～70时放置FOB.FOB进入声门后,两组均静脉注射丙泊酚1 mg/kg,放置气管导管并确定其位置,完成麻醉诱导.记录插管术中及术后情况,记录入室安静后(To)、BIS值降至85时(T1)、环甲膜穿刺后即刻(T2)、BIS值降至80～70时(T3)、FOB放置成功时(T4)和气管内插管成功时(T5)的HR、MAP、Sp02和BIS,记录T1和T3时丙泊酚效应室浓度(effect-site concentration,Ce). 结果 两组气管内插管难易度评分、气管内插管时间、呛咳或误吸率差异均无统计学意义(P＞0.05);与P组比较,D组气道阻塞评分升高(48/7/20/3/0比45/16/4/0/0)、舒适度升高(62/16/0/0/0比35/29/0/1/0)、插管记忆评分升高(60/18/0比62/3/0)、术后咽痛评分升高(22/55/1/0比41/20/4/0),D组血流动力学更稳定,差异有统计学意义(P＜0.05).两组患者T1时丙泊酚Ce差异无统计学意义(P＞0.05);与P组比较,D组T3时丙泊酚Ce降低[(1.00±0.20) mg/L比(1.10±0.30)mg/L](P＜0.05). 结论 负荷剂量Dex(0.5 μg/kg,10 min)辅助表面麻醉用于慢诱导FOB引导经鼻气管内插管可降低丙泊酚的Ce,舒适度更高,但应注意气道阻塞、插管知晓和术后咽痛等并发症.     

颌面外科手术患者视可尼喉镜引导经鼻气管插管的效果

目的 评价颌面外科手术患者视可尼喉镜引导经鼻气管插管的效果.方法 需行经鼻气管插管的颌面外科手术患者100例,ASA分级Ⅰ或Ⅱ级,年龄18～64岁,体重指数＜25 kg/m2.50例术前气道评估基本正常的患者随机分为2组(n=25):Macintosh喉镜引导气管插管组(M组)和视可尼喉镜引导气管插管组(S1组).50例张口度≤3 cm,但无面罩通气困难的患者,随机分为2组(n=25):光导纤维支气管镜引导气管插管组(F组)和视可尼喉镜引导气管插管组(S2组).麻醉诱导后分别置入喉镜引导气管插管,行机械通气.评价喉部显露程度和气管插管过程中鼻出血程度,记录气管插管成功情况、气管插管时间和术后鼻部并发症发生情况.结果 与M组比较,S1组气管插管成功率、一次气管插管成功率和喉部显露程度升高,气管插管时间缩短,鼻出血程度降低(P＜0.05),鼻部疼痛、持续出血和鼻塞的发生率差异均无统计学意义(P＞0.05).与F组比较,S2组气管插管时间缩短(P＜0.05),气管插管成功率、一次气管插管成功率、喉部显露程度、鼻出血程度和鼻部疼痛、持续出血和鼻塞的发生率差异无统计学意义(P＞0.05).结论 视可尼喉镜可更好地显露喉部结构,一次气管插管成功率高,更适用于颌面外科手术患者引导经鼻气管插管.     

不同剂量瑞芬太尼复合靶控输注异丙酚对心脏瓣膜置换术病人气管插管时血液动力学反应的影响

目的 评价不同剂量瑞芬太尼复合靶控输注(TCI)异丙酚对心脏瓣膜置换术病人气管插管时血液动力学反应的影响.方法 拟行心脏瓣膜置换术的风湿性心脏病病人30例,随机分为3组(n=10):芬太尼组(Ⅰ组)、小剂量瑞芬太尼组(Ⅱ组)和大剂量瑞芬太尼组(Ⅲ组).麻醉诱导:Ⅰ组静脉注射芬太尼10 μg/kg,然后持续静脉输注芬太尼10 μg·kg-1·h-1;Ⅱ组和Ⅲ组静脉注射瑞芬太尼1μg/kg,然后分别持续静脉输注瑞芬太尼0.5、1.0 μg·kg-1·min-1.3组静脉注射芬太尼或瑞芬太尼后3min开始TCI异丙酚,初始血浆靶浓度为1.0 μg/ml,逐渐递增至2.0 μg/ml.静脉注射罗库溴铵0.6 mg/kg后气管插管.分别在麻醉诱导前(T0)、诱导期间血压最低值时(T1)、插管前即刻(T2)、插管后1 min(T3)、插管后2 min(T4)及插管后5 min(T5)时记录心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、肺毛细血管楔压(PCWP)、心脏指数(CI)、外周血管阻力指数(SVRI)及左室每搏功指数(LVSWI),并于上述时点测定混合静脉血氧饱和度(S(v)O2).记录诱导期间低血压及气管插管心血管反应的发生情况.结果 3组间麻醉诱导期间低血压及气管插管心血管反应的发生率差异无统计学意义(P＞0.05).与T0比较,各组T1,2时HR和MAP均降低,Ⅱ组T3时HR和MAP升高,Ⅲ组T4时MAP降低,Ⅰ组和Ⅱ组T2-4时S(v)O2升高(P＜0.05);3组间各时点CVP、PCWP、CI、LVSWI和S(v)O2差异无统计学意义(P＞0.05).结论 复合TCI异丙酚(血浆靶浓度2.0 μg/ml)时,静脉注射瑞芬太尼1 μg/kg负荷剂量后,持续静脉输注0.5 μg·kg-1·min-1麻醉诱导时血压和HR下降适度,可较好地抑制心脏瓣膜置换术病人气管插管时血液动力学反应.     

不同剂量艾司洛尔复合异丙酚对气管插管时应激反应的影响

目的 了解艾司洛尔预防气管插管引起的血流动力学变化的合理用量。方法 30例病人随机分为3组。A组为对照组,B组为0．5mg.kg^-1艾司洛尔组,C组为1．0mg.kg^-1艾司洛尔组。静注异丙酚和维库溴铵诱导气管内插管。监测插管后1、3、5及10min收缩压（SP）、舒张压（DP）、心率（HR）;并抽取血标本用高压液相色谱仪测血浆中去甲肾上腺素（NE）、肾上腺素（E）和多巴胺（DA）浓度。结果 A组插管后1min时血压、心率显著升高（P＜0．01）或0．05）。B组插管后3、5及10min时血压、心率显著降低（P＜0．01或0．05）;3及5min时去甲肾上腺素与肾上腺素水平显著降低（P＜0．01或0．05）,与B组比较,插管后1和3min时肾上腺素水平显著降低（P＜0．01）。结论 1．0mg.kg^-1艾司洛尔复合异丙酚可缓解插管时的循环反应及儿茶酚胺反应。     

The effect of ephedrine on intubating conditions and haemodynamics during rapid tracheal intubation using propofol and rocuronium

Background: We compared the effect of pre-treatment with ephedrine 75, 100,150 µg kg^–1 and saline on intubating conditionsand haemodynamics during rapid tracheal intubation using propofoland rocuronium. Methods: One hundred adult patients randomized into one of the four groups—PE75, PE 100, PE 150, and saline (control) groups—were pre-treatedwith i.v. ephedrine 75, 100, 150 µg kg^–1 or saline,respectively, 1 min before rapid tracheal intubation using propofol2.5 mg kg^–1 and rocuronium 0.6 mg kg^–1. A blindedanaesthesiologist assessed the intubating conditions. Heartrate and mean arterial pressure were recorded before anaesthesiainduction (baseline), post-induction, and every minute afterintubation for 5 min. A 20% change in haemodynamic variablesfrom baseline was regarded as clinically significant. Data wereanalysed using ANOVA test with post hoc Tukey's test and ² orFisher's exact test. P < 0.05 was regarded as significant. Results: Patient characteristics, baseline heart rate, and mean arterialpressure were comparable between the groups. Intubating conditionswere significantly better in the PE 75 (P = 0.003) and PE 100(P = 0.001) groups. A significant increase in heart rate wasobserved in the PE 75 and PE 150 groups when compared with thesaline group. A statistically significant difference in meanarterial pressure was noted between PE 75 and PE 150 groupsand between PE 150 and saline groups at most of the time intervals.However, when considering the clinical significance of these,all groups were comparable (P > 0.05). Conclusions: Ephedrine either 75 or 100 µg kg^–1 given beforerapid tracheal intubation using propofol and rocuronium bromideimproves the intubation conditions. It is not effective in preventingthe hypotension which follows ensuing induction of anaesthesia.     

麻醉剂量的丙泊酚对内隐记忆的影响

目的观察麻醉剂量下丙泊酚对内隐记忆及其脑电双频谱指数(BIS)的影响.方法选择42例子宫全切术的病人,随机分为三组.Ⅰ组,Ⅱ组为试验组,各11例.Ⅲ组为对照组20例.三组病人均施予腰麻硬膜外联合麻醉.试验组加用丙泊酚2mg@kg-1,维库溴铵8mg诱导行气管内插管,静脉持续泵入丙泊酚110μg@kg-1@min-1维持麻醉.采用HXD-1型多功能脑电监测仪监测BIS.BIS＞60的病人为I组,BIS＜60的病人为Ⅱ组,关腹后给予内隐记忆听刺激.术后6h测试其模糊辨听率,同时对术中的记忆情况进行调查.结果Ⅰ、Ⅱ组间脑电BIS有显著差异,分别为71.93±10.51和56.04±11.86(P＜0.05).模糊辨听率三组间无差异(P＞0.05).试验组病人无一例存在有外显记忆.结论临床剂量的丙泊酚无论BIS大于或小于60,内隐记忆不能被消除.     

GlideScope视频喉镜、直接喉镜和光导纤维支气管镜经口气管插管时血液动力学反应的比较

目的比较正常气道患者GlideScope视频喉镜(GSVL)、Macintosh直接喉镜(MDLS)和光导纤维支气管镜(FOB)经口气管插管时的血液动力学反应。方法拟在经口气管插管全身麻醉下行择期整形外科手术的患者60例,ASAⅠ或Ⅱ级,年龄18-50岁,随机分为3组(n=20):GSVL组、MDLS组和FOB组。常规麻醉诱导后,分别采用GSVL、MDLS或FOB实施经口气管插管,记录麻醉诱导前(基础值)、气管插管前即刻、气管插管后即刻及插管后1、2、3、4、5min血压(BP)和心率(HR),并记录整个观察期BP和HR的最大值。计算各观察时点的收缩压×心率乘积(RPP)。以时间为横坐标、观察期BP和HR为纵坐标计算血液动力学时-效关系曲线下面积。结果与MDLS组相比,FOB组气管插管时间延长(P<0.05),气管插管后即刻HR和RPP升高(P<0.05),GSVL组各指标差异无统计学意义;与GSVL组相比,FOB组各指标差异无统计学意义;3组血液动力学时-效关系曲线下面积差异均无统计学意义。结论与MDLS和FOB相比,采用GSVL在预防正常气道患者经口气管插管时血液动力学反应方面并无明显优势,但FOB引导经口气管插管时所致的血液动力学反应却强于MDLS。     

The effect of a toothguard on the difficulty of intubation

Dental damage is the most common reason for complaints against anaesthetists. The purpose of this study was to investigate the common belief that the use of a toothguard at the time of intubation causes intubation to be more difficult. We studied 80 patients, half of whom were intubated with a toothguard in situ and the other half intubated without a toothguard. The time taken from mouth opening to successful passage of the tracheal tube through the vocal cords was measured. In the toothguard group, the recorded time also included the time taken to insert the toothguard. The median time to intubation in the group with a toothguard was 24 s and the median time to intubation in the group without a toothguard was 17 s. The difference of 7 s in the time to intubation was statistically significant (p =0.0003). As the recorded times also included the time taken to insert the toothguard, we do not regard this result to be clinically significant and believe that anaesthetists should think carefully before disregarding this simple protective device.     

柳胺苄心定对老年人诱导插管期间血流动力学的影响

目的：观察柳胺苄心定（Ｌａ）在全麻诱导插管期间对老年人血流动力学的影响。方法：２０例老年择期手术病人随机分Ｌａ组（Ｌ组）和对照组（Ｓ组），每组１０例。全麻诱导前分别静脉注射Ｌａ０．５０ｍｇ／ｋｇ和等容生理盐水，后静脉诱导插管。测定用药前至插管后５分钟内不同时间的血流动力学变化。结果：０．５０ｍｇ／ｋｇＬａ能使ＢＰ、ＨＲ、ＳＶＲＩ轻度下降，插管后即刻Ｌ组的ＢＰ、ＨＲ、ＲＰＰ升高幅度比Ｓ组小，组间比较有显著性差异。结论：Ｌａ能大部分阻断插管刺激引起的心血管不良反应。     

右美托咪啶复合靶控输注异丙酚时舒芬太尼抑制双腔气管插管反应的量效关系

目的 确定右美托咪啶复合靶控输注(TCI)异丙酚时舒芬太尼抑制双腔气管插管反应的效应室靶浓度(EC50和EC95).方法 单肺通气全麻胸外科手术患者30例,ASA分级Ⅰ或Ⅱ级,年龄40 ～ 64岁,体重指数＜30 kg/m2.经10 min静脉输注右美托咪啶0.6 μg/kg,随后以0.3μg·kg-1·h-1的速率维持至手术结束前30 min.TCI舒芬太尼3 min后TCI异丙酚,Ce 3 μg/ml,意识消失时静脉注射罗库溴铵0.8 mg/kg行双腔气管插管.采用序贯法进行试验,TCI舒芬太尼初始Ce 0.3 ng/ml,如果前一例患者发生气管插管反应,则下一例患者采用高一级浓度,否则采用低一级浓度,相邻靶浓度之间比率为1.1.气管插管反应的标准:气管插管后3 min内MAP波动幅度超过基础水平15％和/或HR＞90次/min.采用概率单位回归分析法计算舒芬太尼抑制双腔气管插管反应的EC50和EC95.结果 舒芬太尼抑制双腔气管插管反应的EC50为0.23 ng/ml,其95％可信区间为0.20～0.26 ng/ml;抑制双腔气管插管反应的EC95为0.26 ng/ml,其95％可信区间为0.24～0.31 ng/ml.结论 右美托咪啶复合TCI异丙酚时,舒芬太尼抑制双腔气管插管反应的EC50和EC95分别为0.23和0.26 ng/ml.     

The effect of diltiazem on the cardiovascular response to tracheal intubation

The efficacy of diltiazem in the attenuation of the cardiovascular response to laryngoscopy and tracheal intubation was studied in patients who received 0.2 or 0.3 mg/kg diltiazem 60 seconds before the start of laryngoscopy. These data were compared with a control group who received saline. Each group consisted of 10 patients who had elective surgery. Patients who received saline showed a significant increase in mean arterial pressure and rate pressure product associated with tracheal intubation. These increases after tracheal intubation were reduced in diltiazem-treated patients compared with those of the control group (p less than 0.05). The data suggest that a bolus injection of diltiazem is a simple, practical and effective method to attenuate the hypertensive response to laryngoscopy and tracheal intubation.     

Indirect versus direct laryngoscopy for routine nasotracheal intubation

Study Objective

To compare the effectiveness of the indirect laryngoscopes, Airtraq (A) and GlideScope (G), with the Macintosh (M) laryngoscope in routine nasotracheal intubation.

Design

Randomized, single-blinded study.

Setting

University-affiliated, tertiary-care hospital.

Patients

62 adult, ASA physical status 1 and 2 patients with normal airways requiring nasotracheal intubation for dental or maxillofacial surgery.

Intervention

Patients in Groups A and G underwent nasal intubation with the Airtraq and GlideScope, respectively, while laryngoscopy in Group M was performed with the Macintosh blade.

Measurements

Performance of the intubating tools was judged by the ease [Intubation Difficulty Scale (IDS) and numeric rating scale (NRS)] and time to intubation (laryngoscopy and endotracheal tube advancement). In addition, hemodynamic parameters, severity of postoperative sore throat, and posture of the intubator were recorded.

Main Results

IDS score was significantly lower with the Airtraq and GlideScope than with the Macintosh laryngoscope (mean ± SD: A 0.1 ± 0.3, G 0.3 ± 0.6, M 0.8 ± 1.0; P = 0.013). NRS reported by the intubators showed a similar preference for indirect over direct laryngoscopy (A 0.9 ± 0.7, G 1.1 ± 0.6, M 1.9 ± 1.1; P = 0.001). Duration of laryngoscopy and endotracheal tube insertion was similar in all groups. No significant intergroup differences in hemodynamic parameters were recorded. Postoperative sore throat was significantly reduced using the GlideScope compared with the other devices (P = 0.048).

Conclusion

The Airtraq and GlideScope facilitated nasotracheal intubation more so than the Macintosh laryngoscope in adults with apparently normal airways.