A COMPARISON OF HAEMODYNAMIC RESPONSES BETWEEN CLINICAL ASSESSMENT-GUIDED NASOTRACHEAL INTUBATION AND NEUROMUSCULAR BLOCK MONITORING-GUIDED NASOTRACHEAL INTUBATION : A PROSPECTIVE, RANDOMISED STUDY

Dr Asha Sharma, Dr S P Chittora

Abstract


Aim: The aim of study was to compare the effects of nasotracheal intubation on cardiovascular responses when the appropriate
moment for intubation was directed by either clinical judgment or train-of-four assessment.
Method: 60 normotensive, ASA grade I &II patients, aged 18 to 60 years, scheduled for elective maxillofacial surgery under
general anaesthesia selected. In Group M patients, intubation was done after train of four counts became zero in adductor pollicis
muscle, in Group C the intubation was done after the clinical judgment of jaw muscle relaxation. Changes in heart rate (HR) and
mean arterial pressure, intubating conditions and the time between the administration of a neuromuscular blocking agent and
intubation were recorded.
RESULT The two groups were comparable in demographic parameters. HR and mean arterial pressure were significantly higher in
Group C as compared to Group M after intubation (P < 0.05). The mean time required for intubation was significantly shorter in
Group C compared to Group M (193 ± 7 s vs. 403 ± 101 s). Excellent and good intubation conditions were observed in all Group M
patients, But in 22 out of 30 patients (73%) of Group C.
CONCLUSION: Haemodynamic responses to nasotracheal intubation can be significantly attenuated if nasotracheal intubation is
based on neuromuscular monitoring of adductor pollicis muscle.


Keywords


Haemodynamic, neuromuscular monitor, tracheal intubation,

Full Text:

PDF

References


Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J ClinAnesth 1996;8:63-79.

Smith I, Saad RS. Comparison of intubating conditions after rocuronium or vecuronium when the timing of intubation is judged by clinical criteria. Br J Anaesth 1998;80:235-7.

Witkowska M, Karwacki Z, Wierzchowska J, Bukowski P. Neuromuscular block monitoring for optimisation of conditions for endotracheal intubation. AnestezjolIntensTer 2009;41:140-4.

Fuchs-Buder T, Claudius C, Skovgaard LT, Eriksson LI, Mirakhur RK, Viby-Mogensen J; 8th International Neuromuscular Meeting. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: The Stockholm revision. ActaAnaesthesiolScand 2007;51:789-808.

Safavi M, Honarmand A. Attenuation of cardiovascular responses to laryngoscopy and tracheal intubation – Intravenous sufentanil vs. pethidine. Middle East J Anaesthesiol 2008;19:1349-59.

Fassoulaki A, Melemeni A, Paraskeva A, Petropoulos G. Gabapentin attenuates the pressor response to direct laryngoscopy and tracheal intubation. Br J Anaesth 2006;96:769-73.

Carroll MT, Mirakhur RK, Lowry DW, McCourt KC, Kerr C. Neuromuscular blocking effects and train-of-four fade with cisatracurium: Comparison with other nondepolarising relaxants. Anaesthesia 1998;53:1169-73.

Debaene B, Beaussier M, Meistelman C, Donati F, Lienhart A. Monitoring the onset of neuromuscular block at the orbicularis oculi can predict good intubating conditions during atracurium-induced neuromuscular block. AnesthAnalg 1995;80:360-3.

Plaud B, Laffon M, Ecoffey C, Meistelman C. Monitoring orbicularis oculi predicts good intubating conditions after vecuronium in children. Can J Anaesth 1997;44:712-6.

Haller G, Gardaz JP, Bissonnette B. Assessment of intubation time and conditions under the influence of rocuronium. Can J Anaesth 1998;45:312-6

Cheng KI, Chu KS, Chen WC, Tang CS. The train of four ratio decreases to zero in anesthetized children is the guide to achieve a satisfactory intubation condition. Kaohsiung J Med Sci 2002;18:23-9.

Donati F, Meistelman C, Plaud B. Vecuronium neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis. Anesthesiology 1991; 74: 833–7.

Keen RI, Kotak PK, Ramsden RT. Anaesthesia for microsurgery of the larynx. Annals of the Royal College of Surgeons of England1982; 64:111–13

O’Hara DA, Fragen RJ, Shanks CA. Comparison of visual and measured train-of-four recovery after vecuronium-induced neuromuscular blockade using two anaesthetic techniques. Br J Anaesth 1986; 58: 1300–02.

Katz RI, Hovagim AR, Finkelstein HS, Grinberg Y, Boccio RV, Poppers PJ. A comparison of cocaine, lidocaine with epinephrine, and oxymetazoline for prevention of epistaxis on nasotracheal intubation. J Clin Anesth1990; 2: 16–19.


Refbacks

  • There are currently no refbacks.