Hemodynamic Response to Intubation With 4 Different Laryngoscopes in Coronary Artery Bypass Graft Surgery: A Randomized Trial.

OBJECTIVES

To evaluate whether different laryngoscope types influence the hemodynamic stress response to tracheal intubation in adult patients undergoing elective coronary artery bypass graft (CABG) surgery.

DESIGN

Prospective, randomized, controlled clinical trial.

SETTING

University-affiliated tertiary care hospital.

PARTICIPANTS

A total of 112 adult patients scheduled for elective CABG surgery with no anticipated difficult airway.

INTERVENTIONS: Patients were randomly assigned to tracheal intubation using a Macintosh laryngoscope, C-MAC videolaryngoscope, EzVision videolaryngoscope, or McGrath videolaryngoscope under a standardized deep anesthesia protocol.

MEASUREMENTS AND MAIN

RESULTS

Hemodynamic parameters were recorded at predefined time points. The primary outcome was the hemodynamic stress response as changes in mean arterial pressure (ΔMAP) and heart rate (ΔHR) between measurements obtained after anesthesia induction but before neuromuscular blockade (T2) and those obtained 1 minute after tracheal intubation (T4). Mean ΔMAP values were 20.8 ± 19.4 mmHg in the Macintosh group, 26.3 ± 13.6 mmHg in the C-MAC group, 21.8 ± 12.4 mmHg in the EzVision group, and 28.4 ± 11.9 mmHg in the McGrath group (p = 0.168). Corresponding ΔHR values were 7.4 ± 8.2 bpm, 6.1 ± 10.6 bpm, 8.6 ± 16.4 bpm, and 7.5 ± 7.7 bpm, respectively (p = 0.844). When hemodynamic stress response was defined as an increase of ≥10 mmHg in MAP and/or ≥10 beats per minute in heart rate, its incidence was 28.5%, 37.0%, 42.8%, and 42.8% in the Macintosh, C-MAC, EzVision, and McGrath groups, respectively (p = 0.653). Intubation time differed significantly among the groups (median [interquartile range]: 15 [11-18], 19 [12-22], 22 [15-28], and 16 [12-19] seconds, respectively; p < 0.001), whereas intubation success rates and complication profiles were similar across groups.

CONCLUSIONS

Videolaryngoscopes conferred no hemodynamic advantage over direct laryngoscopy during intubation in deeply anesthetized patients undergoing CABG. Adequate anesthesia depth and pharmacologic modulation likely play a more prominent role than device type in blunting intubation stress.