Blood pressure,heart rate and catecholamine response during riberoptic nasotracheal intubation under general anesthesia

Arterial blood pressure (ABP) and heart rate were recorded at one-minute intervals during several stages of intubation in the fiberscope group and the laryngoscope group, to determine if fiberoptic nasotracheal intubation would result in fewer hemodynamic and catecholamine responses than when intubation was performed with a Macintosh laryngoscope. Blood samples were also taken to measure plasma catecholamine concentration immediately after intubation with the fiberscope.The mean ABP in the laryngoscope group was slightly greater than that of the fiberscope group for 4min after intubation. Heart rates at 2min and 4min after intubation in the laryngoscope group were significantly greater than those for the fiberscope group. Even immediately after intubation, the mean plasma levels of epinephrine and norepinephrine were unchanged in the fiberscope group. Arterial oxygen saturation (Sp_{O 2}) was maintaind within normal range during both of intubation procedures, although the time required for intubation was longer than in the laryngoscope group. Other cardiovascular complications were more common in the laryngoscope group than in the fiberscope group.These results suggest that fiberoptic intubation results in less severe stress than does laryngoscopic intubation. Fiberoptic intubation should therefore be used not only in patients with difficult airway, hypertension, ischemic heart disease, or cerebrovascular atherosclerosis, but also it is recommended for all patients for whom nasotracheal intubation is indicated.(Tsubaki T, Aono K, Nakajima T, et al.: Blood pressure, heart rate and catecholamine response during fiberoptic nasotracheal intubation under general anesthesia. J Anesth 6: 474–479, 1992)