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Category: Volume 05 Issue 07 July 2017
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Title: Comparison of the haemodynamic responses to laryngoscopy and intubation with MacIntosh and McCoy laryngoscopy

Authors: Dr Naqeeb Hassan, Dr Mohammad Sadiq, Tantry Tariq Gani

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i7.244

Abstract

Background: Stress response to laryngoscopy and tracheal intubation have a profound influence on the circulatory parameters and the intracranial pressure. The mean increase in arterial pressure of the order of 20-25 mmHg with a maximum rise of 40-45 mmHg has been reported. This peak response occurs approximately 30-45 seconds after laryngoscopy and lasts less than ten minutes. Forces transmitted by the laryngoscope blades on the base of the tongue are assumed to be a major stimulus. Sympathoadrenal response arises from the stimulation of the supraglottic region by the laryngoscope blade. When planning the anaesthesia induction, these effects must be blunted as much as possible.

Materials and Methods: This observational study was conducted at SMHS hospital of government medical college Srinagar. The study was conducted over a period of one year and total number of 100 patients were scheduled for elective procedures by randomly allocating to either Macintosh or McCoy laryngoscopy group. Aim was to Comparision of haemodynamic responses between the two groups. Comparing the time of laryngoscopy and intubation between the two groups and Comparing the laryngeal visualization grading between two groups. An informed written consent was taken from all patients at the time of pre-anaesthetic examination. Laryngoscopy and intubation was performed by standardized anesthetic technique. Size 3 laryngoscope blade was used in all cases. Monitoring include: measurement of noninvasive BP, heart rate (HR), any dysrhythmia .oxygen saturation, end-tidal carbon dioxide, concentration of inhalational anesthetic agent. All values were recorded before induction, immediately before and after laryngoscopy and tracheal intubation, every minute for 5 min following tracheal intubation, and then 10 min after intubation.

Results: The baseline characteristics of the patients in terms of age, weight, height, sex distribution, Mallampati grading and the difference was not statistically significant similar between both the groups which indicated that both the groups were comparable. Maximal rise in heart rate was seen immediately post insertion with mean (107.9) in group A and mean (97.2 ) in group B respectively, and maximal value of standard deviation was seen after 3 min after insertion 4.34 in group A  and  4.29 in group B. On comparison of blood  and mean arterial pressure between two groups blood  and mean arterial pressure was lower in group B with p statistically significant immediately post insertion,1 min and 3 min, and p is statistically insignificant after 5min.

Conclusion: McCoy laryngoscope produces significantly less rise in hemodynamic parameters as compared to Macintosh laryngoscope during laryngoscopy and intubation.

Key Word: McCoy laryngoscope, MacIntosh blade, endotracheal intubation, pressor response.

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Corresponding Author

Tantry Tariq Gani

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