What is the clinical evidence from this study?

Study design: RCT. Population: General anesthesia requiring tracheal intubation (n=60). Intervention: GlideScope or Lightwand laryngoscope vs. Macintosh laryngoscope. Primary outcome: Hemodynamic changes (systolic blood pressure, diastolic blood pressure, and heart rate) before and 1, 3, and 5 minutes after tracheal intubation.

October 31, 2017Anesthesia and Pain MedicineOpen Access

Hemodynamic response to tracheal intubation and postoperative pharyngeal morbidity using GlideScope®, Lightwand and Macintosh laryngoscopes during remifentanil infusion

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Key result

Intubation with GlideScope, lightwand, or Macintosh laryngoscopes during remifentanil infusion resulted in no significant differences in hemodynamic changes or postoperative pharyngeal morbidity.

Why the study?

Does tracheal intubation with GlideScope or Lightwand reduce hemodynamic stress compared to Macintosh laryngoscope in normotensive patients receiving remifentanil?

Study Design

Type

RCT (n=60)

Blinding

Open-label

Randomization

Randomized

Multicenter

Structured PICO

Does tracheal intubation with GlideScope or Lightwand reduce hemodynamic stress compared to Macintosh laryngoscope in normotensive patients receiving remifentanil?

Population

60 ASA class I-II adults aged 20-60 years undergoing general anesthesia were randomized to intubation with GlideScope, lightwand, or Macintosh laryngoscope to assess hemodynamic responses.

Intervention

Tracheal intubation using GlideScope or Lightwand during remifentanil infusion (0.15 mg/kg/min).

Comparator

Tracheal intubation using a direct Macintosh laryngoscope (size 3 blade) during remifentanil infusion.

Outcome

Hemodynamic changes (systolic blood pressure, diastolic blood pressure, and heart rate) measured before and 1, 3, and 5 minutes after tracheal intubation.surrogate

In normotensive patients receiving remifentanil, the choice of laryngoscope (GlideScope, Lightwand, or Macintosh) does not significantly affect hemodynamic responses during tracheal intubation.

Limitations

The study consisted of patients with normal blood pressures and airways, which may not generalize to difficult intubations or hypertensive patients.
Postoperative complications were only checked in the recovery room thirty minutes after surgery.
The study lacked double blinding, which may have introduced selection bias.
Patients requiring more than one minute for intubation were excluded from the analysis.
The use of remifentanil may have masked potential hemodynamic differences caused by the different devices.
Patients had normal blood pressures and airways (not difficult to intubate)
Postoperative complications were only checked in the recovery room 30 minutes after surgery
Patients were not selected using double blinding, so selection may have been prone to bias
Excluded patients requiring multiple attempts or prolonged intubation time (>60 seconds)
Use of remifentanil might have had a greater effect in alleviating glottal stimulation, masking differences between devices

Discussion

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Implication

Any laryngoscope may be selected without concern for differential hemodynamics; confirms device equivalence in remifentanil-anesthetized normotensive patients.

Cite This Study

Jeon et al. (2017) conducted an RCT in General anesthesia requiring tracheal intubation (n=60). GlideScope or Lightwand laryngoscope vs. Macintosh laryngoscope was evaluated on Hemodynamic changes (systolic blood pressure, diastolic blood pressure, and heart rate) before and 1, 3, and 5 minutes after tracheal intubation. Intubation with GlideScope, lightwand, or Macintosh laryngoscopes during remifentanil infusion resulted in no significant differences in hemodynamic changes or postoperative pharyngeal morbidity.

synapsesocial.com/papers/6a8f2d5acfbae50cb43237fb https://doi.org/10.17085/apm.2017.12.4.342

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Implication

Any laryngoscope may be selected without concern for differential hemodynamics; confirms device equivalence in remifentanil-anesthetized normotensive patients.

Hemodynamic response to tracheal intubation and postoperative pharyngeal morbidity using GlideScope®, Lightwand and Macintosh laryngoscopes during remifentanil infusion

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Hemodynamic response to tracheal intubation and postoperative pharyngeal morbidity using GlideScope®, Lightwand and Macintosh laryngoscopes during remifentanil infusion

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider