Hemodynamic Changes after Endotracheal Intubation in Patients with Cerebral Aneurysm

Yoon, Cherry; Park, Kwan Sik; Park, Sung Yong; Chae, Yun Jeong; Min, Sang Kee; Lee, Sook Young; Park, Hyung Ju; No, Hyun Ju; Moon, Bong Ki

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Clinical Research

Neuroanesthesia

Anesthesia and Pain Medicine 2008;3(1):49-54.
Published online January 30, 2008.

Hemodynamic Changes after Endotracheal Intubation in Patients with Cerebral Aneurysm

Cherry Yoon, Kwan Sik Park, Sung Yong Park, Yun Jeong Chae, Sang Kee Min, Sook Young Lee, Hyung Ju Park, Hyun Ju No, Bong Ki Moon

Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea. mbk@ajou.ac.kr

Abstract

BACKGROUND
Tracheal intubation with a lightwand intubating device (Trachlight) attenuates the hemodynamic stress response to tracheal intubation compared with a direct laryngoscope approach. We compared the effects of the direct laryngoscope (Macintosh blade) and lightwand for intubation in patients with cerebral aneurysm. METHODS: Twenty-four patients undergoing cerebral aneurysm clipping surgery were randomly divided to either the lightwand (Group 1, n = 12) or the laryngoscope (Group 2, n = 12) Group. All patients received fentanyl (2-3microg/kg), midazolam (0.1 mg/kg), and thiopental sodium (2-3microg/kg) followed by vecuronium (0.1- 0.15microg/kg). The lungs were ventilated with 3-4% isoflurane in oxygen, with 1% lidocaine (1-1.5microg/kg) administered before intubation with either the lightwand or the laryngoscope. Systolic, diastolic and mean blood pressures and heart rate were recorded continuously before and for 5 min after intubation. RESULTS: Systolic and mean arterial blood pressure increased significantly (P < 0.05) 1 minute after intubation, but then returned to normal within the next minute. There were no differences in hemodynamic changes between the two groups, and no complications. CONCLUSIONS: Intubation technique did not affect hemodynamic changes in patients with cerebral aneurysm. In patients with aneurysms, appropriate anesthetic levels and pharmacologic manipulation will attenuate the hemodynamic stress response associated with tracheal intubation.

Key Words: cerebral aneurysm, laryngoscope, lightwand, tracheal intubation

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