A comparative study of hemodynamic responses to orotracheal intubation with fiberoptic bronchoscope and laryngoscope in children

BACKGROUND: The purposes of this study were to further identify the hemodynamic responses to orotracheal intubation in children, using a fiberoptic bronchoscope (FOB) and a direct laryngoscope (DLS), and to validate whether the FOB can attenuate the hemodynamic response to orotracheal intubation compared with the DLS. METHODS: Forty-three children, ASA PS I-II scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were randomly allocated to either the DLS group (n = 20) or the FOB group (n = 23). Noninvasive systolic blood pressure (SBP) and heart rate (HR) were recorded before (baseline values) and after anesthesia induction (postinduction values), at intubation and every minute for the first 5 min after intubation. The maximal values of SBP and HR during the observation were also recorded. The product of HR and SBP [rate pressure product (RPP)] at each time point was calculated. RESULTS: In the DLS group, SBP, HR, and RPP at intubation and 1 min after intubation were significantly higher than postinduction values, but did not exceed baseline values. In the FOB group, SBP, HR, and RPP at intubation increased significantly compared with baseline and postinduction values. In the two groups, the maximal values of SBP, HR, and RPP during the observation were significantly higher than baseline values. Except for the HR at intubation, there were no significant differences in other hemodynamic parameters during the observation and the time required to reach maximal values of SBP, HR, and RPP between the two groups. CONCLUSIONS: Orotracheal intubation using FOB and DLS in children may cause similar increases in SBP and HR. Compared with the DLS, the FOB had no advantage in attenuating the hemodynamic responses to orotracheal intubation.