Comparison of cardiovascular responses to airway management: fiberoptic intubation using a new adapter, laryngeal mask insertion, or conventional laryngoscopic intubation.

STUDY OBJECTIVES: To evaluate the circulatory effects of fiberoptic intubation with a newly developed mask adapter and to compare these effects with those obtained with a conventional laryngoscope and laryngeal mask airway with general anesthesia.

DESIGN: Randomized study.

SETTING: Operating room at a university hospital.

PATIENTS: 30 ASA physical status I adult patients scheduled for minor elective surgery.

INTERVENTIONS: A Macintosh laryngoscope was used for intubation in Group L (n = 10), a fiberoptic bronchoscope with newly developed mask adapter was used in Group FI (n = 10), and a laryngeal mask airway was used in Group LMA (n = 10). Anesthesia was induced with thiamylal, fentanyl, and vecuronium. Patients were manually ventilated for 4 minutes with sevoflurane. Then their tracheas were intubated with a laryngoscope or fiberoptic bronchoscope, or a laryngeal mask airway was inserted.

MEASUREMENTS AND MAIN RESULTS: Blood pressure (BP) and heart rate (HR) were measured continuously. After intubation, the magnitude of change of both BP and HR was greatest in Group L, next highest in Group FI, and lowest in Group LMA.

CONCLUSION: Fiberoptic intubation with general anesthesia using the newly developed mask adapter offers an advantage over the standard laryngoscope for patients in whom pressor response of intubation is potentially hazardous.