11. Comparison of hemodynamic responses to intubation: Flexible fibreoptic bronchoscope versus McCoy laryngoscope in presence of rigid cervical collar simulating cervical immobilization for traumatic cervical spine

Background: Intubation is known to cause exaggerated hemodynamic response in form of tachycardia, hypertension and dysrrhythmias. In cervical spine immobility or instability, intubation has to be performed using cervical immobilization to prevent exacerbation of spinal cord injuries. Application of rigid cervical collar may reduce cervical spine movements, but it hinders tracheal intubation with standard laryngoscope. It significantly reduces the mouth opening, rendering laryngoscopy difficult and also lifts up the chin and tips the larynx anteriorly. The aim of this study is to compare the hemodynamic responses to fibreoptic bronchoscope and McCoy laryngoscope in patients undergoing elective surgery under general anesthesia with rigid cervical collar simulating cervical spine immobilization in the situation of cervical trauma. Materials and Methods: Thirty two patients in age range 20-50 years, of ASA I - Π, and of either sex undergoing elective surgery under general anesthesia were randomly allocated into each group. There were two groups according to the technique used for intubation: Group A (Flexible Fibreoptic Bronchoscope) and group B (McCoy Laryngoscope). Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean arterial blood pressure (MAP) and heart rate (HR) were recorded at baseline, intra-operatively, immediately before and after induction, and immediately after intubation. Thereafter, every minute for the next five minutes. Demographic data is presented as numbers and intergroup comparison of these was done by Chi square test. The value of P < 0.05 was considered statistically significant. Quantitative data is presented as mean values and standard deviation. Intergroup comparison of quantitative data was done by parametric test (unpaired t-test) and probability was considered to be significant if less than <0.05. Results: The demographic data is comparable. Due to intubation response, heart rate and blood pressure increased significantly (P < 0.05) above preoperative values in McCoy group as compared to fibreoptic group. Conclusion: We suggest that the flexible fibreoptic bronchoscope is an effective and better method of intubation in situation like traumatic cervical spine injury and provides stable hemodynamics.

No conflict of interest has been declared by the author(s).