Laryngoscopic View And Cardiovascular Response to Intubation With Truview Laryngoscope in Comparison with Macintosh Laryngoscope

  • Dr . NaliniKotekar
  • Published 2016

Abstract

BACKGROUND AND OBJECTIVE: Macintosh laryngoscope is one of the gold standard instrument used for tracheal intubation TruViewEVO2 blade incorporates a non-magnifying optic port with an anterior fraction of 42 ͦ which enable a better field for intubation. The purpose of this study was to evaluate the TruView laryngoscope in comparison to Macintosh laryngoscope with regard to cardiovascular response and laryngoscopic view. MATERIALS AND METHODS: 200 Adult patients(20-60yrs) with American Society of Anaesthesiologistsgrade I and II, Mallampati grade I and II posted for surgery under general anaesthesia at JSS Hospital, Mysore divided into two groups of 100 each. Laryngoscopic view and Hemodynamic response were assessed with statistical analysis. RESULTS In group T, 65 (65%) patients had Cormack and LehanegradingI, 33 (33%) patients had Cormack and Lehane grading II and 2 (2%) patients had Cormack and Lehane grading III. In group M, 42 (42%) patients had Cormack and Lehane grading I and 57 (57%) patients had Cormack and Lehane grading II and 1(1%) patient had Cormack and Lehane grading III The differences in the Cormack and Lehane between the two groups were statistically highly significant (p = 0.003).Group T mean heart rate increased from 85.540±14.67866 beats per minute prior to intubation to 94.5200±15.08259 beats per minute after intubation and mean arterial pressure increased from 92.7850±12.39260 mmHg prior to intubation to 101.2550±13.19825 mmHg after intubation. In Group M, mean heart rate increased from 84.7900±7.99153 bpm prior to intubation to 103.6100±9.30721 bpm after intubation and mean arterial pressure increased from 91.7070±8.08478mmHg prior to intubation to 97.1410±7.71946 mmHg after intubation(p=0.000). CONCLUSION TruView laryngoscope provides a better exposure of the glottis when compared to Macintosh laryngoscope while triggering minimum haemodynamic response to endotracheal intubation. INTRODUCTION Securing and maintainance of airway is one of the major responsibilities of an anaesthesiologist. The curved laryngoscope blade described by Macintosh in 1943 is the most popular device used to facilitate orotracheal intubation and constitutes a gold standard.2 Most of tracheal intubations performed daily are effortless. However, difficult tracheal intubation, which occurs in 1.5–13% of general anaesthetics can be associated with severe morbidity 1. In a case of difficult intubation, either the larynx cannot be visualised using conventional direct laryngoscopy, or the larynx is visualised but it is difficult to pass the tube into the trachea, wherin using macintosh may not be useful to visualize the glottis always, leading to invention of newer devices like Airtraq, Video assisted laryngoscope such as TruViewEVO2, King Vision laryngoscope and others. The process of laryngoscopy is known to have profound cardiovascular effects. This includes pressor response and tachycardia along with an increase in catecholamine concentration, mainly norepinephrine. The major cause of this response is believed to arise from stimulation of supraglottic region by laryngoscopic blade with tracheal tube placement and cuff inflation contributing little additional stimulation.3, 4 Transitory hypertension and tachycardia are probably of no consequences in healthy individuals, but they may be hazardous to those with hypertension, myocardial insufficiency or cerebrovascular diseases. Complications of pressor response following laryngoscopy include myocardial ischemia, cardiac failure, intracranial haemorrhage and increase in intracranial pressure.5,6 In 2006, the TruphatekTruViewEVO2 system (Truphatek International Limited, Netanya, Israel) was introduced for adult airway management and in 2009..The blade of the laryngoscope has a magnified optic side port that provides a wide, magnified laryngeal view at a 46 ̊ anterior refracted angle, allowing a view of the glottis via the prismatic lens without having to align the oral, pharyngeal, and tracheal axes The tool has a narrower blade tip than does the Macintosh blade and an integrated oxygen jetcleaning system (flow 10 l/min-1) to prevent fogging and provide apneic oxygenation.7 The purpose of this study is to evaluate the effectiveness of a Truview laryngoscope in comparison to an English blade Macintosh laryngoscope while performing a tracheal intubation with regard to cardiovascular response and laryngoscopic view. Materials and Methods At the start of this study TruViewEVO2 was a novel device hence we wanted to assess its usage in visualization of glottis in patients with apparently normal airway charecteristics. 200 patients of either sex in the age group of 20-60 years undergoing elective surgery under general anaesthesia at JSS Hospital attached to JSS Medical College,Mysore from September 2013 to March 2015 were included in the study. In this study, evaluation and comparison of the differences in observations made using TruViewEVO2 laryngoscope and Macintosh laryngoscope in terms of Cormack and Lehane grading of laryngeal view, haemodynamic response and complications were studied. After Institutional Ethical Committee approval and written informed consent, patients posted for various elective surgeries requiring general anaesthesia were selected. All the patients were explained in their colloquial language about the procedure. Two hundred (200) patients of either sex scheduled for different elective surgeries under general anaesthesia requiring endotracheal intubation were randomly allocated to one of the two groups of 100 patients each group.

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Cite this paper

@inproceedings{NaliniKotekar2016LaryngoscopicVA, title={Laryngoscopic View And Cardiovascular Response to Intubation With Truview Laryngoscope in Comparison with Macintosh Laryngoscope}, author={Dr . NaliniKotekar}, year={2016} }