Cardiovascular response and backward, upward, right push maneuver during laryngoscopy: comparison between CMAC® video laryngoscopy and conventional Macintosh

  • Arif H.M. Marsaban Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta
  • Aldy Heriwardito Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta
  • I G.N.A.D. Yundha Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta
Keywords: BURP maneuver, cardiovascular response, CMAC®, conventional Macintosh, laringoscopy
Abstract viewed: 1781 times
PDF downloaded: 714 times
HTML downloaded: 70 times
EPUB downloaded: 115 times

Abstract

Background: Increased blood pressure and heart rate are the most frequent response to laryngoscopy which sometimes causes serious complications. Laryngoscopy technique and tools modification lessen the nociceptive stimulation, thus preventing hemodynamic response. BURP maneuver is used to lower Cormack-Lehane level, but it can cause additional pain stimulation during laryngoscopy. The aim of this study was to compare the cardiovascular response and the need of BURP maneuver during laryngoscopy between CMAC® and conventional Macintosh.

Methods: A randomized, single blinded, control trial was performed to 139 subjects who underwent general anesthesia with endotracheal tube. Subjects were randomised into a control group (conventional Macintosh) and an intervention group (CMAC®). The cardiovascular parameters (systolic, dyastolic, mean arterial pressure, and heart rate) were measured prior to induction (T1). Midazolam 0.05 mg/kg and Fentanyl 2 micrograms/kg were given 2 minutes before the induction. Moreover, they were given propofol 1 mg/kg followed by propofol infusion of 10 mg/kg/hour and Atracurium 0.8-1 mg/kg. After TOF-0 cardiovascular parameters (T2) were remeasured, it was proceeded to laryngoscopy. When Cormack-Lehane 1â2 was reached (with or without BURP maneuver), cardiovascular parameters were measured again (T3).

Results: Unpaired T-test showed that cardiovascular response during laryngoscopy were significantly lower in the intervention group compared to the control group (p<0.05). The need of BURP maneuver was significantly lower in the CMAC® group compared to the Convensional Macintosh group (13.9% vs 40.3%; p<0.05).

Conclusion: Cardiovascular response and BURP maneuver during laryngoscopy with CMAC® were significantly lower compared to conventional Macintosh.

Downloads

Download data is not yet available.

References

  1. Hagberg CA, Artime CA. Airway management in adult. In: Miller RD, Weiner-Kronish JP, Young WL, editors. Miller's anesthesia. 8th ed. Philadelphia. Elsevier Saunders; 2015. p. 1647-83.

  2. Hassani V, Movassaghi G, Goodarzi V, Safari S. Comparison of fentanyl and fentanyl plus lidocaine on attenuation of hemodynamic responses to tracheal intubation in controlled hypertensive patients undergoing general anesthesia. Anesth Pain Med. 2013;2(3):115-8. https://doi.org/10.5812/aapm.6442

  3. Chaundary B, Shah SM, Sarvaiya VU. Comparative study of two different doses of fentanyl citrate 2 microgram/kg and 4 microgram/kg intravenous in attenuation of hemodynamic responses during intubation. NHL Journal of Medical Science. 2013;2(2):41-3.

  4. Deem SA, Bishop MJ, Bedford RF. Physiologic and patophysiologic responses to intubation. In : Hagberg CA, editor. Benumof's airway management. 2nd ed. Philadelphia. Mosby Inc; 2007. p. 193-214 https://doi.org/10.1016/B978-032302233-0.50010-X

  5. Kapuangan C, Soenarto RF, Marsaban AHM. Respons kardiovaskular pada laringoskopi intubasi : Perbandingan antara esmolol 100 mg dengan lidokain 1.5 mg [thesis]. Jakarta: Universitas Indonesia; 2008. p. 1-5. Indonesian.

  6. Kanchi M, Nair HC, Banakal S, Murthy K, Murugesan C. Haemodynamic response to endotracheal intubation in coronary artery disease: direct versus video laryngoscope. Indian J Anesth. 2011;55(3):260-5. https://doi.org/10.4103/0019-5049.82673

  7. Rosenblatt, WH. Airway Management In : Barash PG, Cullen BF, Stoelting RK, editors. Clinical Anesthesia. 5th Ed. Lippincot & Wilkins. Philadelphia;2006. p. 595-643.

  8. Thomas EBM, Moss S. Tracheal intubation. Anesth and Intens Care Med.2014;15(1):5-7. https://doi.org/10.1016/j.mpaic.2013.11.007

  9. Butterworth IV JF, Mackey DC, Wasnic JD, editors. Airway management. In : Morgan and Mikhail's clinical anesthesiology. 5th Ed. New York: Lange; 2013. p. 308-41.

  10. Aziz M. The role of video laryngoscopy. Adv in Anesth. 2013;31:87-98. https://doi.org/10.1016/j.aan.2013.08.009

  11. Niforopulou P, Pantazopoulos I, Demestiha T, Koudouna E, Xanthos T. Video-laryngoscopes in adult : A topical review of the literature. Acta Anesthesiol Scand. 2010;54(9):1050-61. https://doi.org/10.1111/j.1399-6576.2010.02285.x

  12. Charters S, Charters P. Alternative techniques for tracheal intubation. Anesth Intens.2014;15(5):209-14. https://doi.org/10.1016/j.mpaic.2014.03.001

  13. Dominguez-Roldan JM, Barrera-Chacon JM, Murillo-Cabezas F, Santamaria-Mifsut JL, Rivera-Fernandez V. Clinical factors influencing the increment of blood carbon dioxide during the apnea test for the diagnosis of brain death. Transplantation Proceeding. 1999;31:2599-600. https://doi.org/10.1016/S0041-1345(99)00518-7

  14. Murphy MF, Barker TD, Schneider RE. Endotracheal intubation in: Wals RM, Murphy MF, editors. Manual of emergency airway management. 3rd ed. Lippincot Williams & Wilkins. Philadelphia; 2008. p. 63-75.

  15. Rosenquist RW, Vrooman BM. Chronic pain management. In: Butterworth IV JF, Mackey DC, Wasnic JD, editors. Morgan and Mikhail's clinical anesthesiology. 5th Ed. New York. Lange; 2013. p. 1023-85.

  16. Lubenow TM, Ivankovich AD, Barkin R. Management of acute postoperative pain. In: Barash PG, Cullen BF, Stoelting RK, editors. Clinical Anesthesia. 5th Ed. Lippincot & Wilkins. Philadelphia; 2006. p. 1405-40.

  17. Noppens RR, Geimer S, Eisel N, David M, Piepho T. Endotracheal intubation using the C-MAC® video laryngoscope or the macintosh laryngoscope: A prospective, comparative study in the ICU. Crit Care. 2012;16(3):1-8. https://doi.org/10.1186/cc11384

  18. Anonymous. Video intubation systems in storz the world of endoscopy. 5th ed. Tuttlingen: Karl Storz Corp; 2012. p. 61-3.

  19. McElwain J, Malik MA, Harte BH, Flyn NM, Laffey JG. Comparison of the CMAC® video laryngoscope with the macintosh, glidescope®, and airtraq® laryngoscope in easy and difficult laryngoscopy scenarios in manikins. Anaesthesia. 2010;65(5):483-9. https://doi.org/10.1111/j.1365-2044.2010.06307.x

  20. Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anaesth. 1996;8(1):63-79. https://doi.org/10.1016/0952-8180(95)00147-6

  21. Kautto UM. Attenuation of the circulatory response to laryngoscopy and intubation by fentanyl. Acta Anaesthesiol Scand. 1982;26(3):217-21. https://doi.org/10.1111/j.1399-6576.1982.tb01757.x

Published
2017-08-18
How to Cite
1.
Marsaban AH, Heriwardito A, Yundha IG. Cardiovascular response and backward, upward, right push maneuver during laryngoscopy: comparison between CMAC® video laryngoscopy and conventional Macintosh. Med J Indones [Internet]. 2017Aug.18 [cited 2024Oct.10];26(2):116-21. Available from: https://mji.ui.ac.id/journal/index.php/mji/article/view/1505
Section
Clinical Research