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. 2015;7(1):54-63.

Haemodynamic response at double lumen bronchial tube placement - Airtraq vs. MacIntosh laryngoscope, a randomised controlled trial

Thomas Hamp  1 , Thomas Stumpner  1 , Georg Grubhofer  1 , Kurt Ruetzler  1 , Rainer Thell  1 , Helmut Hager  1
Affiliations

Haemodynamic response at double lumen bronchial tube placement - Airtraq vs. MacIntosh laryngoscope, a randomised controlled trial

Thomas Hamp et al. Heart Lung Vessel. 2015.

Abstract

Introduction: Tracheal intubation causes a haemodynamic response that might be harmful for patients. The Airtraq® laryngoscope has been shown to decrease the haemodynamic response to single-lumen tube intubation. We hypothesised that double-lumen bronchial tube placement with the Double-lumen Airtraq® laryngoscope would cause a reduced haemodynamic response and decreased catecholamine release compared with the MacIntosh laryngoscope.

Methods: Forty adult patients were randomly assigned to the Airtraq® group or to the MacIntosh group. Intubation with either the Airtraq® or the MacIntosh laryngoscope was performed two minutes after standardised induction of anaesthesia. Arterial blood pressure, heart rate, catecholamine levels, bispectral index and duration of the intubation procedure were measured.

Results: Mean (standard deviation [95% confidence interval]) systolic arterial blood pressure at laryngoscopy with the Airtraq® laryngoscope was 124 (34 [106 to 141]) mmHg and, with the MacIntosh laryngoscope, it was 110 (25 [99 to 122]) mmHg (p=1.0). Heart rate at laryngoscopy with the Airtraq® laryngoscope was 75 beats·min-1 (16 [67 to 83]) and, with the MacIntosh laryngoscope, it was 64 beats·min-1 (14 [58 to 71]) (p=0.71). Adrenaline levels post-intubation were 54.3 ng·l-1 (41.5) [29.3 to 79.4] in the Airtraq® group and 30.5 ng·l-1 (25.6) [15.1 to 46.0] in the MacIntosh group (p=0.016). The duration of intubation with the Airtraq® laryngoscope was 88 s (31 [72-104]) while, with the MacIntosh laryngoscope, the duration was 75 s (35 [59-92]) (p=0.26).

Conclusions: The use of the Double-lumen Airtraq® laryngoscope provides no benefit regarding stress response compared to the MacIntosh laryngoscope.

Keywords: double-lumen-tube; haemodynamics; intubation; stress response.

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Conflict of interest statement

Disclosures None declared.

Figures

Table 1
Table 1
Characteristics of patients who received double-lumen-bronchial tube insertion with either the MacIntosh or the Airtraq® laryngoscope. Values are the mean (SD) [95% CI] or number (proportion). ASA = American Society of Anesthesiologists; SD = standard deviation; CI = confidence interval.
Figure 1
Figure 1
Course of systolic arterial blood pressure (mean, 95% CI) in patients using the MacIntosh (grey) or the Airtraq® (black) laryngoscope. CI = confidence interval.
Table 2
Table 2
Blood pressure at different time points in patients who received double-lumen-bronchial tube insertion with either the MacIntosh or the Airtraq® laryngoscope. Values are the mean (SD) [95% CI]. SAP = systolic arterial blood pressure; MAP = mean arterial blood pressure; DAP = diastolic arterial blood pressure. SD = standard deviation; CI = confidence interval
Figure 2
Figure 2
Course of heart rate (mean, 95% CI) in patients using the MacIntosh (grey) or the Airtraq® (black) laryngoscope. CI = confidence interval.
Table 3
Table 3
Heart rate and catecholamine levels at different time points in patients who received double-lumen-bronchial tube insertion with either the MacIntosh or the Airtraq® laryngoscope. Values are the mean (SD) [95% CI]. The concentrations of noradrenaline, adrenaline and dopamine are given in ng´l-1. HR= heart rate min-1; SD = standard deviation; CI = confidence interval.
Table 4
Table 4
Bispectral index at different time points in patients who received double-lumen-bronchial tube insertion, measured with either the MacIntosh or the Airtraq® laryngoscope. Values are the mean (SD) [95% CI]. BIS = Bispectral index; SD = standard deviation; CI = confidence interval.
Table 5
Table 5
Characteristics of the intubation procedure in patients who received double-lumen-bronchial tube insertion with either the MacIntosh or the Airtraq® laryngoscope. Values are the mean (SD) [95% CI] or number (proportion). *“easy” includes: “very simple” and “simple”; “difficult” includes: “difficult” and “very difficult”; †”correct” in the left main bronchus, “incorrect” any position other than in the left main bronchus. SD = standard deviation; CI = confidence interval.
Figure 3
Figure 3
Changes in catecholamine concentrations through the study period (post intubation minus baseline levels) in patients receiving DLT intubation with either the MacIntosh- (grey) or the Airtraq® (black) laryngoscope. Values are the mean (SD) [95% CI]. DLT = double lumen-bronchial-tube; SD = standard deviation; CI = confidence interval.
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