RESEARCH ARTICLE


Revisited: Haemodynamic Instability and Endocrine Response During Endotracheal Tube-Placement. A Prospective, Randomized Trial Using Topical Lidocaine and a Lightwand



B. Dünges1, F. Heid1, M. Dauster1, U. Strecker1, B. Röhrig3, A.M. Brambrink*, 1, 2
1 Department of Anesthesiology, Johannes Gutenberg-University Mainz, Germany
2 Department for Anesthesiology and Peri-Operative Medicine, Oregon Health & Science University, Portland, OR 97239, USA
3 Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg-University, Germany


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Creative Commons License
Dünges et al.; Licensee Bentham Open

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Anesthesiology, Johannes Gutenberg-University Mainz, Germany; E-mail: brambrin@ohsu.edu


Abstract

Endotracheal intubation via direct laryngoscopy frequently provokes cardiovascular side-effects. Although using a lightwand intubation device reduces laryngeal stimulation, previous reports indicated a similar stress response compared to classical laryngoscopy. We hypothesized that endotracheal tube (ET) placement itself elicits haemodynamic instability and that topical anaesthesia can attenuate this response.

Methods:

30 patients were randomized to three groups (n = 10 each). After induction of general anaesthesia (fentanyl, etomidate, vecuronium) 5 ml of test solution was applied to laryngo-tracheal structures via a lightwand guided EDGARTube ®. Control group received 5 ml saline 0.9%, group lido 1% 5 ml lidocaine 1%, and group lido 2% 5 ml lidocaine 2%. After 2 minutes of bag-mask ventilation lightwand guided ET placement was performed. Invasive systolic arterial pressure (SAP, mmHg), heart rate (HR, bpm) and arterial plasma concentrations of catecholamines ([adr][nor], pcg ml-) were determined.

Results:

After ET placement control group patients showed increased HR and SAP (mean Δ HR = 15.3; mean Δ SAP = 45.6) compared to both lido groups (Δ HR: lido1%/2% = 5.8/3.7; Δ SAP: lido1%2% = 8.7/13.0). Catecholamine concentrations also increased only in the control group (mean Δ [adr] = 101.43; Δ [nor] = 89.41) but not in lido groups (Δ [adr]: lido1%/2% = -12.93/7.05; Δ [nor]: lido1%/2% = -6.61/-30.55). Effect size calculation indicated strong clinical effects of topical lidocaine for almost all variables (ES > 0.8).

Conclusion:

ET placement into the non-anaesthesized trachea causes haemodynamic and endocrine stress even if direct laryngoscopy is omitted. Topical anaesthesia effectively reduces this response.

Keywords: Airway, stimulation, anaesthesia techniques, topical, laryngoscopy.