Latorre F, Hofmann M, Kleemann P P, Dick W F
Klinik für Anästhesiologie, Johannes Gutenberg-Universität Mainz.
Anaesthesist. 1993 Jul;42(7):423-6.
Nasotracheal intubation of the trachea by means of fiberoptic endoscopy is an accepted approach to difficult airways. The associated avoidance of direct laryngoscopy may affect the stress response to nasotracheal intubation. We tested this hypothesis by means of a prospective, randomized, controlled clinical study. METHODS. Informed consent was obtained from 30 patients presenting for maxillofacial surgery for participation in this study. Patients were allocated to three groups: nasotracheal intubation to be performed either fiberendoscopically (group 1) or laryngoscopically, with (group 2) or without (group 3) topical anaesthesia of the larynx. Haemodynamic variables (arterial blood pressure and heart rate) and concentrations of catecholamines* in plasma (adrenaline, noradrenaline; HPLC) were documented at four (two*) time points, respectively: prior to induction of anaesthesia*, after induction, 1 min after tracheal intubation*, 5 min after tracheal intubation. Differences between time points and between groups were analysed with the chi-square test; a probability of P < 0.05 was considered statistically significant. RESULTS. With respect to age, body-weight and gender, the groups were comparable. No major hemodynamic or endocrine stress responses were observed in any group. Diastolic blood pressures were significantly lower in groups one and two, one minute after tracheal intubation. DISCUSSION. Nasotracheal intubation does not provoke a major stress response, when performed in accordance with the protocol of this study. However, topical anaesthesia of the larynx, as well as the fiberendoscopic approach proved superior to control with respect to diastolic arterial pressure. We conclude that fiberoptic nasotracheal intubation, or laryngoscopy preceded by topical anaesthesia of the larynx may be useful in patients for whom an increase in rate pressure product would be undesirable.
通过纤维光学内窥镜进行气管的鼻气管插管是处理困难气道的一种公认方法。避免直接喉镜检查可能会影响对鼻气管插管的应激反应。我们通过一项前瞻性、随机、对照临床研究来验证这一假设。方法：获得30例因颌面外科手术前来就诊的患者的知情同意，让其参与本研究。患者被分为三组：一组通过纤维内窥镜进行鼻气管插管（第1组）；二组通过喉镜进行鼻气管插管，同时对喉部进行局部麻醉（第2组）；三组通过喉镜进行鼻气管插管，但不对喉部进行局部麻醉（第3组）。分别在四个（两个*）时间点记录血流动力学变量（动脉血压和心率）以及血浆中儿茶酚胺的浓度（肾上腺素、去甲肾上腺素；高效液相色谱法）：麻醉诱导前、诱导后、气管插管后1分钟*、气管插管后5分钟。使用卡方检验分析时间点之间以及组间的差异；P<0.05被认为具有统计学意义。结果：在年龄、体重和性别方面，各组具有可比性。任何一组均未观察到明显的血流动力学或内分泌应激反应。气管插管后1分钟，第1组和第2组的舒张压显著降低。讨论：按照本研究方案进行鼻气管插管时，不会引发明显的应激反应。然而，就舒张压而言，喉部局部麻醉以及纤维内窥镜方法优于对照组。我们得出结论，对于那些不希望心率血压乘积增加的患者，纤维光学鼻气管插管或在喉部局部麻醉后进行喉镜检查可能是有用的。
