Users Online: 4529 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 


RSACP wishes to inform that it shall be discontinuing the dispatch of print copy of JOACP to it's Life members. The print copy of JOACP will be posted only to those life members who send us a written confirmation for continuation of print copy.
Kindly email your affirmation for print copies to dranjugrewal@gmail.com preferably by 30th June 2019.

 

 
Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 36  |  Issue : 2  |  Page : 233-237

Evaluation of King's vision videolaryngoscope and glidescope on hemodynamic stress response to laryngoscopy and endotracheal intubation


Department of Anesthesia and Surgical ICU, Faculty of Medicine, Tanta University, Tanta, Egypt

Date of Submission10-Jun-2018
Date of Acceptance20-Jun-2019
Date of Web Publication15-Jun-2020

Correspondence Address:
Dr. Nagat S EL-Shmaa
Department of Anesthesia, Surgical ICU and Pain Medicine, Faculty of Medicine, Tanta University, Tanta
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joacp.JOACP_183_18

Rights and Permissions
  Abstract 


Background and Aims: We hypothesis that the use of novel airway devices would decrease hemodynamic stress response (HDSR) to laryngoscopy and endotracheal (ET) intubation. The aim of our study was to evaluate the hemodynamic stress response (HDSR) to laryngoscopy and tracheal intubation using the King vision video laryngoscope (KVVL) versus glidescope (GLS).
Material and Methods: A prospective randomized, comparative study that was conducted on 80 patients of both sexes; American Society of Anesthesiologists physical status I and II with no anticipated difficult airway, aged 20–60 years; who were scheduled for elective surgical procedure under general anesthesia. Patients were randomly allocated into two groups (40 each). Group I: laryngoscopy and tracheal intubation were carried out using KVVL, Group II: laryngoscopy and tracheal intubation were carried out using GLS. The two groups were compared for noninvasive hemodynamic data such as heart rate and mean arterial pressure. Time to successful intubation and number of attempts were recorded. Hemodynamic parameters were recorded at the preinduction, after induction, at intubation, 1 min, 3 min, 5 min, 10 min, and 15 min.
Results: There was significant decrease (P < 0.05) in HR and MBP in both groups just before intubation. In comparison with the baseline, HR and MBP in group I and group II increased but this difference was not significant at 3 min and 5 min after intubation and returned to the baseline at 10 min after intubation and below the baseline at 15 min after intubation. Also, there were no significant differences in the hemodynamic response between the studied groups.
Conclusion: Novel airway devices either KVVL or GLS are efficient in reducing HDSR to laryngoscopy and ET intubation.

Keywords: Endotracheal intubation, glidescope, hemodynamic stress response, the King Vision video laryngoscope


How to cite this article:
EL-Shmaa NS. Evaluation of King's vision videolaryngoscope and glidescope on hemodynamic stress response to laryngoscopy and endotracheal intubation. J Anaesthesiol Clin Pharmacol 2020;36:233-7

How to cite this URL:
EL-Shmaa NS. Evaluation of King's vision videolaryngoscope and glidescope on hemodynamic stress response to laryngoscopy and endotracheal intubation. J Anaesthesiol Clin Pharmacol [serial online] 2020 [cited 2020 Jul 11];36:233-7. Available from: http://www.joacp.org/text.asp?2020/36/2/233/286790




  Introduction Top


Airway manipulation during endotracheal (ET) intubation results in tracheolaryngeal, epipharyngeal, and parapharyngeal nociceptors stimulation leading to significant increase of catecholamine levels that causes hemodynamic stress response (HDSR) to ET intubation.[1]

HDSR may be dangerous in susceptible patients having poor cardiac function or with other cardiac diseases, such as those with hypertension, coronary artery disease, cerebrovascular disease and intracranial aneurysm, and may lead to arrhythmias, myocardial infarction, left ventricle failure, or aneurysm rupture. The degree of the HDSR is different and related to the force used during the glottis visualization and the airway manipulation during ET intubation.[2] Recently, there are novel videolaryngoscopes that do not require airway manipulation like upward or forward force to optimize glottis vision during ET intubation. The glidescope was developed in 2001 by John Pacey of Canada.[3] This video laryngoscope can provide an enlarged video image of airway constructions.[4]

The King Vision video laryngoscope (KVVL) is an indirect laryngoscope, which produces glottis visualization without vertical alignment axes of the oral, pharyngeal, and tracheal structures.[5]

The KVVL consists of 2.4 inch reusable display and a disposable rigid blade. Two types of blade are present: one is a channeled one which allows ET tube to be advanced through the glottis, and the other blade is a non-channeled one that just permits glottis visualization, and ET intubation is helped by a metal stylet.[6]

The objective of this study was to evaluate hemodynamic stress response (HDSR) to ET intubation using the KVVL versus glidescope (GLS). We hypothesised that the use of novel airway devices would decrease hemodynamic stress response (HDSR) to laryngoscopy and ET intubation.


  Material and Methods Top


This is a prospective, randomized, and comparative study conducted at our university hospital and carried out on 80 adult patients of both sexes during the period from December 2017 to May 2018 after approval from the hospital Ethical Committee and written informed consent of the patient were taken. We followed The CONSORT 2010 statement in reporting this clinical trial.

Inclusion criteria were American Society of Anesthesiologists (ASA) physical status I–IIwith no anticipated difficult airway, age between 20 and 60 years, Mallampati class 1 and 2 and patients scheduled for elective surgical procedure under general anesthesia.

Exclusion criteria were known allergy to the anesthetic agents, history of major psychiatric disorders, cervical spine injury, history of substance abuse and current opioid use, increased intracranial pressure, history of gastroesophageal reflux needing rapid sequence induction, hypertension, ischemic heart diseases, those on drugs with cardiovascular effects and whom intubation attempts lasted longer than 15 s (unanticipated difficult intubation).

Randomization was carried out through a computer-generated, random number schedule. The random number schedule was generated by means of the QuickCalcs (GraphPad Software Inc., La Jolla, CA, USA). The group assignment numbers were sealed in an opaque envelope and kept by the supervisor of the study. After the written consent was taken, the opaque envelope was unsealed to detect which airway device would be used.

Patients were allocated randomly into two groups (40 each):

Group I: ET intubation was carried out using KVVL,

Group II: ET intubation was carried out using GLS.

All patients were intubated with ET tube internal diameter 7 mm for adult female and 7.5 mm for adult male and with a low-pressure, high-volume cuff (Kendall Curity tracheal tube, MA, USA).

All patients were fasting for at least 8 h. In the operating room, all patients received antibiotic prophylaxis with ceftriaxone 1 g intravenously within 1 h prior surgical procedure. All patients were premedicated by midazolam 0.02 mg/kg I.V. Baseline parameters, such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded by the anesthetist who was blinded about the type of airway device used (most of the data was recorded and printed by an electronic device). All patients were preoxygenated with 100% oxygen for 3 min via gently placed anesthesia face mask. Induction of anesthesia was carried out by IV fentanyl 2 mcg/kg, propofol 2 mg/kg, and rocuronium 0.6 mg/kg to facilitate ET intubation, then rocuronium 0.15 mg/kg IV was given as a maintenance dose. Anesthesia was maintained with sevoflurane two Minimum Alveolar Concentration (MAC) in 100% oxygen. Mechanical ventilation of the lungs was performed and the concentration of end-tidal carbon dioxide was kept between 30 and 40 mmHg. No surgical stimulation or any other type of stimulus was applied throughout the 15 min period of study. Hemodynamic parameters and any adverse effect were recorded at 1 min, 3 min, 5 min, 7 min, 10 min, and 15 min after ET intubation. All the ET intubations were carried out by a well-trained anesthetist with more than 10 years' experience in the field of specialty, also with more than 50 successful ET intubations with both airway devices. Cessation of the attempt was done if SpO2 decreased below 92% or caused trauma of airway as blood stain over the blade of the airway device. Manual ventilation was carried out in between the trials. Failed ET intubation was considered if two attempts were unsuccessful or if malfunction of airway devices after that algorithm of failed intubation was followed.[7] Intubation time was measured from the time the airway device blade entered the mouth till the end-tidal CO2 tracing was observed on the monitor after mechanical ventilation commenced. Laryngoscopy and ET intubation was performed according to the patient's group. Attempts number, external assist maneuvers, and any complications as airway trauma, bronchospasm, esophageal intubation, or desaturation were recorded. The primary outcome was the hemodynamic changes and the secondary outcome were intubation time, the numbers of intubation attempt, external assist maneuvers, and the incidence of postoperative sore throat.

Statistical analysis

Sample size calculation was carried out by using Epi-Info software statistical package made by World Health organization and Center for Disease Control and Prevention, Atlanta, Georgia, USA version 2002. The following criteria were used for calculation of sample size: 95% confidence and 80% power. Sample size and power of analysis was calculated on the basis of previous study[5],[6] to detect 20% difference in hemodynamic as BP and HR, it was necessary to include 37 patients per group, Therefore, we decided to recruit 40 patients per group to compensate for those dropping out during the study. The Windows version of SPSS 17.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. The Kolmogorov–Smirnov test was used to verify the normal distribution of continuous variables. Normally distributed continuous variables were compared using unpaired Student's t-test.

All results presented in form of mean ± standard deviation (SD). Descriptive data were analyzed by two-tailed Student's t-test. HR, systolic, diastolic, and mean blood pressures analysis were performed using a repeated-measures analysis of variance. Pearson' Chi-square test was used to analyze categorical variables. Power of significance (P value < 0.05) was considered statistically significant.


  Results Top


Out of the 93 patients who were evaluated for eligibility, 80 adult patients were enrolled in the study, and the results of 80 patients were analyzed. Both groups were comparable in demographic variables with respect to age, gender, body mass index (BMI), ASA physical status, airway characteristics as regards Mallampati class 1/2/3/4 and thyromental distance (mm), preinduction hemodynamic variables as regards preinduction HR, MAP, attempts' number for successful ET intubation, the lowest SpO2 during ET intubation, end-tidal CO2 at the time of ET intubation, and other airway parameters [Table 1]. Time taken to intubation was comparable between GLS and KVVL [42.7 (12.3) vs. 41 (10.8) min, P = 0.7]. Also, there was more need for external neck manipulation with GLS but the differences between groups were statistically insignificant. Patients in group I (KVV group) had statistically significant lower incidence of postoperative sore throat than group II (GLS group) and no failure of intubation was recorded [Table 1].
Table 1: Demographic variables, airway characteristics, and preinduction hemodynamic variables

Click here to view


There was significant decrease (P< 0.05) in HR and MBP in both groups just before intubation and it was due to induction of anesthesia [Figure 1] and [Figure 2]. In comparison with the baseline HR and MBP in group I and group II increased but this difference was not significant at 3 min and 5 min after intubation and returned to the baseline at 10 min after intubation and below the baseline at 15 min after intubation. Also, there were no significant differences in the hemodynamic response between the studied groups.
Figure 1: Heart rate changes (beat/min) in both studied groups

Click here to view
Figure 2: Mean blood pressure changes (mmHg) in both studied groups

Click here to view



  Discussion Top


Laryngoscopy and ET intubation are associated with hemodynamic changes and lead to increase in HR and BP which may cause harmful complications with these HDSR responses.[8] Video laryngoscope leads to optimum visualization of airway constructions via magnified video image.[9]

The major findings of the present study were that: In comparison with the baseline values, HR and MBP in group I and group II increased but this difference was not significant at 3 min and 5 min after intubation and returned to the baseline at 10 min after intubation and below the baseline at 15 min after intubation. Also there were no significant differences in the hemodynamic response between the studied groups. Intubation time was slightly longer with GLS as compared to KVVL. Moreover, there is more need for external neck manipulation with GLS but the differences between groups were statistically insignificant. Patients in group I (KVV group) had statistically significant lower incidence of postoperative sore throat than group II (GLS group) and no failure of intubation was recorded.

Aqil[10] assessed hemodynamic response to tracheal intubation performed by GLS and found no statistically significant difference in hemodynamic response to intubation. Another study by Elhadi et al.;[6] compared the Macintosh laryngoscope with the KVVL in ET intubation and demonstrated that the KVVL was more effective in decreasing hemodynamic stress responses to ET intubation, optimizing the laryngoscopic view with increasing success rate, performing ET intubation, and decreasing the need of external maneuvers throughout ET intubation.

Also in agreement with our results, Lee et al.;[11] compared The Pentax-AWS, Glidescope videolaryngoscope, and KVV for difficult airway intubation and found that time for tracheal intubation was shorter with KVV than Glidescope.

Kanchi et al.;[12] evaluated if the indirect video laryngoscope has any benefits over conventional laryngoscopy and ET intubation in cardiac patients and in contrast to our study, they demonstrated that videolaryngoscope did not provide any advantages in hemodynamic stress response to ET intubation. However, the patient sample was heterogeneous and Pentax-AWS was used.

Also, in contrast to our results, Al-Ghamdi et al.;[13] evaluated the efficacy of different type of videolaryngoscopes on the time to tracheal intubation and concluded that KVL required longer time to tracheal intubation than glidescope and this difference can be explained by the use of videolaryngoscopes by anesthesiologists with limited experience, while in the same study the incidence of postoperative sore throat was in accordance to our results.

No failure of intubation or significant airway complications was recorded in our study. In accordance with our results Ali et al.;[14] observed less airway trauma when using KVL which may be related to the absence of airway maneuver and having a soft blade. However, in contrast to our results, Jagannathan et al.;[15] compared KVL with the Miller laryngoscope and demonstrated that complications were not significantly different between devices. Also, Soliman et al.[16] reported increased incidence of airway trauma and bleeding due to ET intubation with GlideScope than with Macintosh laryngoscope.

Limitation of the study: first, the HDSR was not studied in high-risk subjects as cardiac and hypertensive patients or patients with anticipated or actual difficult intubation. Second, we did not rely on objective method for studying HDSR of ET intubation as plasma catecholamine levels. Third, the potential for bias presents, as it is impossible to blind the anesthetist to the airway device being used. To solve this problem, we chose a reasonably well-experienced anesthetist and the data were recorded and printed by an electronic device, so, the potential of bias can be reduced.


  Conclusion Top


Novel airway devices either KVVL or GLS are efficient in reducing HDSR to laryngoscopy and ET intubation.

Acknowledgements

The authors would like to thank the nurses at the Operation Theatre of Tanta University Hospital, Tanta for their assistance in conducting the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kahl M, Eberhart LH, Behnke H, Sanger S, Schwarz U, Vogt S, et al. Stress response to tracheal intubation in patients undergoing coronary artery surgery: Direct laryngoscopy versus an intubating laryngeal mask airway. J Cardiothorac Vasc Anesth 2004; 18:275-80.  Back to cited text no. 1
    
2.
Perkins ZB, Wittenberg MD, Nevin D, Lockey DJ, O'Brien B. The relationship between head injury severity and hemodynamic response to tracheal intubation. J Trauma Acute Care Surg 2013; 74:1074-80.  Back to cited text no. 2
    
3.
Carassiti M, Zanzonico R, Cecchini S, Silvestri S, Cataldo R, Agrò FE. Force and pressure distribution using Macintosh and GlideScope laryngoscopes in normal and difficult airways: Amanikin study. Br J Anaesth 2012;108:146-51.  Back to cited text no. 3
    
4.
Channa AB. Video laryngoscopes. Saudi J Anaesth 2011; 5:357-9.  Back to cited text no. 4
  [Full text]  
5.
Kamal S, Ali QE, Amir SH, Ahmed S, Pal K. King vision video laryngoscope versus lightwand as an intubating device in adult patients with Mallampatti grade III and IV patients. J Clin Anesth 2016;34:483-9.  Back to cited text no. 5
    
6.
Elhadi SM, Rady WK, Elfadly AM. A comparative study between the macintosh laryngoscope and the king vision video laryngoscope in endotracheal intubation. Res Opin Anesth Intensive Care 2016; 3:168-72.  Back to cited text no. 6
  [Full text]  
7.
Frerk C, Mitchell VS, McNarry AF, edonca C, Bhagrath R, Patel A, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015; 115:827-48.  Back to cited text no. 7
    
8.
Keniya VM, Ladi S, Naphade R. Dexmedetomidine attenuates sympathoadrenal response to tracheal intubation and reduces perioperative anaesthetic requirement. Indian J Anaesth 2011; 55:352-7.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Kihara S, Brimacombe J, Yaguchi Y, Watanabe S, Taguchi N, Komatsuzaki T. Hemodynamic responses among three tracheal intubation devices in normotensive and hypertensive patients. Anesth Analg 2003;96:890-5.  Back to cited text no. 9
    
10.
Aqil M. A study of stress response to endotracheal intubation comparing glidescope and flexible fiberoptic bronchoscope. Pak J Med Sci 2014;30:634-8.  Back to cited text no. 10
    
11.
Lee S, Kang H, Oh J, Lim TH, Lee Y, Kim C. Comparison of Pentax-AWS, Glidescope® and King Vision® laryngoscope for difficult airway intubation in manikin's model by paramedics. Hong Kong J Emerg Med 2017;24:237-43.  Back to cited text no. 11
    
12.
Kanchi M, Nair HC, Banakal S, Murthy K, Murugesan C. Haemodynamic response to endotracheal intubation in coronary artery disease: Direct versus video laryngoscopy. Indian J Anaesth 2011;55:260-5.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Al-Ghamdi AA, Eltahan MR, Khidr AM. Comparison of the Macintosh, Glidescope® Airtraq® and King Vision® laryngoscope in routine airway management. Minerva Anestesiol 2016; 82:1278-87.  Back to cited text no. 13
    
14.
Ali QE, Amir SH, Jamil S, Ahmad S. A comparative evaluation of the Airtraq® and King Vision® videolaryngoscope as an intubating aid in adult patients. Acta Anaesth Belg 2015;66:81-5.  Back to cited text no. 14
    
15.
Jagannathan N, Hajduk J, Sohn L, Huang A, Sawardekar A, Albers B, et al. Randomized equivalence trial of the King Vision a Blade videolaryngoscope with the Miller direct laryngoscope for routine tracheal intubation in children<2 yr of age. Br J Anaesth 2017;118:932-7.  Back to cited text no. 15
    
16.
Soliman R, Mofeed M, Alamoudy O, Farouk A. A prospective randomized comparative study between Macintosh and GlideScope in adult patients undergoing cardiac surgery. Egypt J Cardiothoracic Anesth 2015;9:8-13.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
   Abstract
  Introduction
  Material and Methods
  Results
  Discussion
  Conclusion
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed68    
    Printed1    
    Emailed0    
    PDF Downloaded18    
    Comments [Add]    

Recommend this journal