Amini Shahram, Shakib Majid
Department of Anesthesiology and Critical Care, Mashhad University of Medical Sciences, Mashhad, Iran.
Buali Hospital, Artesh University of Medical Sciences, Birjand, Iran.
Anesth Pain Med. 2015 Mar 30;5(2):e21836. doi: 10.5812/aapm.21836. eCollection 2015 Apr.
Endotracheal intubation is usually associated with hemodynamic changes, especially in patients undergoing cesarean section by general anesthesia. GlideScope® videolaryngoscope (GVL) is a novel video laryngoscope, which does not need direct exposure of vocal cords and produces lesser hemodynamic changes due to lower degrees of trauma and stimuli to oropharynx than the Macintosh direct laryngoscope (MDL).
The aim of this study was to compare hemodynamic changes following endotracheal intubation with GVL and MDL in patients undergoing cesarean section by general anesthesia.
Seventy patients undergoing elective cesarean section by general anesthesia requiring endotracheal intubation were randomly allocated to be intubated with either GVL (n = 35) or MDL (n = 35). Systolic, diastolic and mean arterial blood pressure (MAP), as well as pulse rates, and rate pressure product (RPP) were compared at baseline, after induction of anesthesia, and after intubation at one-minute interval for five minutes between the two groups. The patients were also compared for Mallampati score, sore throat, intubation time and neonates' Apgar scores.
The patients were similar regarding systolic, diastolic and mean arterial blood pressure. Pulse rate changes were significantly lower only at 1 and 3 minutes in the GVL group. The intubation times were 9.3 ± 1.4 and 10.6 ± 1.7 seconds in the MDL and GVL groups, respectively (P > 0.05). RPP was also lower in the GVL group at 1 and 2 minutes (P < 0.05) and returned to baseline afterwards. There was no significant difference between the groups for Mallampati score, sore throat and Apgar scores.
Our study revealed that hemodynamic parameters with GVL are only better preserved in the first three minutes after intubation in patients undergoing elective cesarean section and patients are similar regarding intubation time, sore throat and Apgar score.
气管插管通常会伴随血流动力学变化，尤其是在接受全身麻醉剖宫产的患者中。GlideScope®视频喉镜（GVL）是一种新型视频喉镜，它无需直接暴露声带，并且由于对口咽部的创伤和刺激程度低于麦金托什直接喉镜（MDL），因此产生的血流动力学变化较小。
本研究旨在比较全身麻醉下行剖宫产的患者使用GVL和MDL进行气管插管后的血流动力学变化。
70例接受全身麻醉择期剖宫产且需要气管插管的患者被随机分为两组，分别使用GVL（n = 35）或MDL（n = 35）进行插管。比较两组患者在基线、麻醉诱导后以及插管后每隔1分钟共5分钟时的收缩压、舒张压和平均动脉压（MAP）、心率以及心率血压乘积（RPP）。还比较了两组患者的马兰帕蒂评分、咽痛情况、插管时间和新生儿阿氏评分。
两组患者的收缩压、舒张压和平均动脉压相似。仅在GVL组中，1分钟和3分钟时心率变化显著较低。MDL组和GVL组的插管时间分别为9.3±1.4秒和10.6±1.7秒（P>0.05）。GVL组在1分钟和2分钟时RPP也较低（P<0.05），随后恢复至基线水平。两组在马兰帕蒂评分、咽痛情况和阿氏评分方面无显著差异。
我们的研究表明，对于接受择期剖宫产的患者，使用GVL时血流动力学参数仅在插管后的前三分钟得到更好的维持，且两组患者在插管时间、咽痛情况和阿氏评分方面相似。
