Comparison of hemodynamic responses to laryngoscopy and tracheal intubation using Macintosh and AirtraQ® laryngoscope in patients with simulated cervical spine injury

Laryngoscopyand tracheal intubation are associated with varied levels of sympatheticstimulation. The accompanying increase in heart rate and blood pressure canhave deleterious effects. Patients with cardio vascular compromise, elderly,neurological insult requires measures to curb or avoid these changes. Variouspharmacological agents have been used to blunt the fluctuations in hemodynamicparameters. The choice of airway equipment can also play a role in the severityof sympathetic stimulation to laryngoscopy and intubation. There is mechanicalstretch and stimulation of structures of the airway during laryngoscopy. Themagnitude of cardio vascular response is related to the force and duration oflaryngoscopy. The alterations in hemodynamic parameters have deleteriouseffects on patient physiology and is best avoided or attenuated.Most oftenpatients after trauma have associated head injury. This subgroup requiresmaintenance of hemodynamic and intracranial pressure. However not many studieshave compared the difference with respect to hemodynamic changes among variousairway equipments. [1]The AirtraQ® is a novelintubation device that has been developed to facilitate tracheal intubation inpatients with normal or difficult airways. The blade of the AirtraQ**®**consists of two side byside channels. One channel acts as a conduit through which a tracheal tube(ETT) can be passed, whilst the other channel contains a series of lenses,prisms and mirrors that transfers the image from the illuminated tip to aproximal viewfinder, giving a high quality wide-angle view of the glottis andsurrounding structures, and the tip of the tracheal tube.[2]

Patients with suspected cervical injury requiringintubation depend on such airway device as alignment between oral, pharyngealand laryngeal axes are not required. Macintosh laryngoscope blade is still themost widely used airway device also being used in patients needing manual inline stabilization. Thus we wish to compare these two devices for use inpatients with simulated cervical spine injury with respect to the hemodynamicfluctuations produced in each of them.