Haemodynamic response to nasotracheal intubation under general anaesthesia: Comparison between fiberoptic bronchoscopy and direct laryngoscopy

To compare haemodynamic response in nasotracheal intubation under general anaesthesia between FOB and DLS as one accomplished with a FOB is thought to attenuate the circulatory responses to intubation as stimulation of the oropharyngeal structures may be avoided.

Randomized, prospective study.

50 ASA grade I and II patients of both sexes in the age group of 18–60 years scheduled for an elective surgery under general anesthesia.

Patients were randomly allocated to nasotracheal intubation facilitated with either the FOB [Group I] or the DLS [Group II]. A uniform protocol of anesthesia was used.

Heart Rate [HR], Systolic Blood Pressure [SBP], Diastolic Blood Pressure [DBP] & Mean Arterial Pressure [MAP] in the two groups were compared at their baseline, post-induction values, at the time of insertion of the scope, immediately after intubation & at 3, 5 and 10 minutes after intubation.

Haemodynamic response in the form tachycardia, increase in SBP, DBP & MAP occurred in nasotracheal intubations with both the fiberoptic bronchoscope and with direct laryngoscope. Tachycardia of similar magnitude was noted in both the groups following insertion of scope and after intubation whereas SBP, DBP & MAP were significantly high in Group II [p<0.01] at the time of intubation & SBP immediately after intubation was significantly high in Group I [p<0.05] Conclusions: Fiberoptic bronchoscopy provides no advantage over conventional laryngoscopy, in terms of decreasing the hemodynamic response to nasotracheal intubation under general anaesthesia.