Comparative clinical study of attenuation of hemodynamic response to laryngoscopy and endotracheal intubation using clinical assessment guidance versus neuromuscular block monitoring guidance

Nebu CA, Shalini Y, Sonika S, Manjunath HG, Priya L

Pdf Page Numbers :- 213-217

Christine Ann Nebu^1,*, Shalini Y², Sonika S³, Manjunath HG⁴ and Lakshmi Priya¹

¹Department of Anaesthesiology, Sacred Heart Medical Center, Kottayam, Kerala 686001, India

²Department of Anaesthesiology, Mysore Medical College and Research Institute, Mysuru, Karnataka 570001, India

³Department of Anaesthesiology, Janani Anaesthesia and Critical Care Services, Shivamogga, Karnataka 577201, India

⁴Department of Anaesthesiology, Chamarajanagar Institute of Medical sciences, Chamarajanagar, Karnataka 571313, India

*Corresponding author: Dr. Christine Ann Nebu, Department of Anaesthesiology, Mysore Medical College and Research Institute, Mysuru, Karnataka 570001, India. Email: ann.christine.nebu@gmail.com

Received 23 March 2024; Revised 22 April 2024; Accepted 3 May 2024; Published 23 May 2024

Citation: Nebu CA, Shalini Y, Sonika S, Manjunath HG, Priya L. Comparative clinical study of attenuation of hemodynamic response to laryngoscopy and endotracheal intubation using clinical assessment guidance versus neuromuscular block monitoring guidance. J Med Sci Res. 2024; 12(3):213-217. DOI: http://dx.doi.org/10.17727/JMSR.2024/12-40

Copyright: © 2024 Nebu CA et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PDF

Abstract

Background: The hemodynamic response to the stress of laryngoscopy and endotracheal intubation does not present a problem for most patients, except in cardiovascular or cerebral disease. Various anesthetic techniques and drugs are available to control the hemodynamic response to laryngoscopy and intubation. However administration of an additional drug may adversely affect hemodynamics of the patient or unnecessarily increase the depth of anesthesia. Hence a non pharmacological measure to reduce response is preferred. The purpose of this study was to compare the hemodynamic response during laryngoscopy and intubation when choice of the moment of intubation is directed by either clinical assessment and neuromuscular monitoring with train of four.

Methods: A total of 60 patients were randomised into two groups. In Group M endotracheal intubation was done after train of four count became zero in adductor pollicis muscle. In Group C timing of intubation was determined clinically by assessment of jaw muscle relaxation. Changes in heart rate (HR), systolic BP (SBP), diasolic BP (DBP), mean arterial pressure (MAP), time between the administration of neuromuscular blocking agent and endotracheal intubation was recorded. Results were analysed by the analysis of variance and chi square test.

Results: Heart rate, SBP, DBP and mean arterial pressure were significantly higher in Group C as compared to Group M after laryngoscopy and endotracheal intubation (P<0.05). The mean time required for onset of intubation was significantly shorter in Group C compared to Group M.

Conclusion: The objective assessment of neuromuscular relaxation prior to endotracheal intubation provides better attenuation of hemodynamic responses.

Keywords: hemodynamic response; laryngoscopy; endotracheal intubation; neuromuscular block