A PROSPECTIVE RANDOMIZED STUDY FOR COMPARATIVE EVALUATION OF HAEMODYNAMIC DERANGEMENTS USING VLSCOPE (VIDEO LARYNGOSCOPE), LIGHT WAND AND CONVENTIONAL MACINTOSH LARYNGOSCOPE AS INTUBATING DEVICES IN ADULT SURGICAL PATIENTS

A  PROSPECTIVE RANDOMIZED  STUDY FOR COMPARITIVE  EVALUATION  OF  HAEMODYNAMIC DERANGEMENTS  USING  VLSCOPE (VIDEO LARYNGOSCOPE), LIGHT WAND AND CONVENTIONAL MACINTOSH  LARYNGOSCOPE AS  INTUBATING  DEVICES  IN ADULT  SURGICAL  PATIENTS.

Zoya Khan**, Qazi Ehsan Ali*

Department of Anesthesiology and Critical Care, JNMCH, AMU, Aligarh

**Presenting author, * Professor

INTRODUCTIONThe technique of laryngoscopy consists of proper positioning, opening of the mouth, inserting the laryngoscope blade, positioning it in the valleculla and applying force to raise the epiglottis and then insert the endo-tracheal tube through the vocal cords into the trachea. One of the most teleological functions of the larynx is that of airway protection, which is primarily provided by means of glottic closure reflex Apart from the airway, this process induces various changes in different physiological systems of the body.

 Laryngoscopy and intubation are an intense noxious stimulus for the body. Among the various systems, of importance is the cardio vascular system, wherein the response occurs via the vagal and the glossopharyngeal afferents that result in a reflex autonomic activation. This manifests as reflex tachycardia and hypertension in adults and adolescents, whereas autonomic activation in children and infants results in reflex bradycardia.

 The heart rate and blood pressure are known to fluctuate in the post intubation period. Another parameter is the Rate–pressure product (RPP), it was originally described by Katz & Feinberg (1958) as an index of ‘cardiac effort’ and correlation with oxygen consumption was confirmed in humans by Kitamura et al. (1972). RPP is linearly correlated with oxygen consumption. It is of equal importance in cardiac compromised patients.

 Studies have also established that the magnitude of cardiovascular response is related to the force applied to lift the glottis and the duration of laryngoscopy. All this being established for patients with no co-morbidities present, the knowledge regarding the changes in cardiovascular parameters are of absolute necessity in case any co morbidity factors are present. For example, hypotension is relatively common in patients with poor LV function, hypertension may be induced due to sympathetic stimulation during laryngoscopy; following the stress of tracheal intubation kidney transplant patients may develop hypotension before surgical incision.The resultant sympathetic response and the resulting hemodynamic response have been extensively studied and documented in different patient groups, both with and without cardiac illness.

 The choice of anesthetic techniques should be selected while keeping the patient’s cardiac patho-physiology and other co-morbid conditions in mind.No single set ‘algorithm’/’recipe’ can guarantee hemodynamic stability during anesthetic induction.

 The purpose of the present study is to compare the hemodynamic changes using three different devices, namely the new VLSCOPE (video laryngoscope), Light wand and the conventional Macintosh laryngoscope for as an intubating in elective adult surgical patients.

 Video laryngoscopy is relatively recent development that improves the success of tracheal intubation. They have revolutionized the practice of airway, and are now included in the ASA “Difficult Airway Algorithm†as an alternative approach to intubation. Numerous studies have already been performed and in place to compare and evaluate the physiological altercations caused by the newer instruments in the ever evolving field of airway management.

MATERIAL AND METHODS

Elective endotracheal intubation will be carried out in adult sugrical patients using VLSCOPE (video laryngoscope), Light wand and conventional Macintosh laryngoscope in 30 patients in each group.

Haemodynamcis derrangements in terms of  heart rate, mean arterial blood pressure and rate pressure product shall be recoded and are the primary objectives of this study. Furthermore, secondary objectives that include time for intubation, success rate, number of attempts, number of adjustment maneuvers for successfull intubation, ease of intubation, any incidence of airway trauma or any post operative sore throat shall also recorded.

The results will be compared amongst the three groups.

RESULTS

The study will be started after 2 weeks. Above quoted parametres will be recorded and compared.