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Blood pressure and heart rate changes during fibreoptic orotracheal intubation: a comparison of children and adults

Published online by Cambridge University Press:  20 June 2006

F. S. Xue ,
G. H. Zhang ,
H. T. Sun ,
C. W. Li ,
K. P. Liu ,
Y. C. Xu  and
Y. Liu
F. S. Xue
Affiliation:
Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Anaesthesiology, Beijing, People's Republic of China
G. H. Zhang
Affiliation:
Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Anaesthesiology, Beijing, People's Republic of China
H. T. Sun
Affiliation:
Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Anaesthesiology, Beijing, People's Republic of China
C. W. Li
Affiliation:
Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Anaesthesiology, Beijing, People's Republic of China
K. P. Liu
Affiliation:
Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Anaesthesiology, Beijing, People's Republic of China
Y. C. Xu
Affiliation:
Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Anaesthesiology, Beijing, People's Republic of China
Y. Liu
Affiliation:
Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Anaesthesiology, Beijing, People's Republic of China
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Extract

Summary

Background and objectives: Autonomic circulatory regulation and airway anatomy in children are significantly different from those in adults. There is no available published data to compare whether there is a clinically relevant difference in the haemodynamic responses to fibreoptic orotracheal intubation (FOI) under the same conditions between children and adults. In this randomized clinical study, we compared the blood pressure (BP) and heart rate (HR) changes during FOI in 40 children aged 3.5–9 yr and 40 adults aged 21–57 yr, ASA 1 scheduled for elective plastic surgery under general anaesthesia requiring orotracheal intubation. Methods: Anaesthesia was induced with intravenous (i.v.) injection of fentanyl and propofol, and face mask inhalation of isoflurane before FOI. Noninvasive BP and HR were recorded before induction (baseline values), after induction (postinduction values), at intubation and for 5 min after intubation at 1-min intervals. The percentage changes of BP and HR at each time point were calculated. Results: In children and adults, HR at intubation and 1–3 min after intubation were significantly higher than baseline and postinduction values. In adults, BP at intubation increased significantly compared to the postinduction values but did not exceed baseline values. In children, BP at intubation and 1 min after intubation were significantly higher than postinduction and baseline values. As compared to adults, FOI caused a more significant pressor response in children. The percentage changes of BP at intubation and 1 min after intubation were larger in children than in adults. However, there was no significant difference in the percentage change of HR during the observation between children and adults. Conclusions: Under general anaesthesia, FOI might cause a more significant pressor response in children than in adults.

Keywords

INTUBATION, INTRATRACHEAL, fibreoptic bronchoscopeANAESTHESIA GENERALCARDIOVASCULAR PHYSIOLOGYCHILDRENADULTSHAEMODYNAMIC PHENOMENA, blood pressure, heart rate
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 1 , January 2007 , pp. 39 - 45
Copyright
© 2006 European Society of Anaesthesiology

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References

Finfer SR, MacKenzie SI, Saddler JM, Watkins TG. Cardiovascular responses to tracheal intubation: a comparison of direct laryngoscopy and fibreoptic intubation. Anaesth Intensive Care 1989; 17: 44–48.Google Scholar
Sun HY, Xue FS, Li P et al. A comparative study of haemodynamic responses to orotracheal intubation with fibreoptic bronchoscope and direct laryngoscope. Forum Anesth Mon (Chinese) 2003; 10: 262–365.Google Scholar
Schaefer HG, Marsch SC, Strebel SP, Drewe J. Cardiovascular effects of fibreoptic oral intubation: a comparison of a total intravenous and a balanced volatile technique. Anaesthesia 1992; 47: 1034–1036.Google Scholar
Adachi YU, Takamatsu I, Watanabe K, Uchihashi Y, Higuchi H, Satoh T. Evaluation of the cardiovascular responses to fiberoptic orotracheal intubation with television monitoring: comparison with conventional direct laryngoscopy. J Clin Anesth 2000; 12: 503–508.Google Scholar
Adachi YU, Satomoto M, Higuchi H, Watanabe K. Fentanyl attenuates the hemodynamic response to endotracheal intubation more than the response to laryngoscopy. Anesth Analg 2002; 95: 233–237.Google Scholar
Smith JE, King MJ, Yanny HF, Pottinger KA, Pomirska MB. Effect of fentanyl on the circulatory responses to orotracheal fibreoptic intubation. Anaesthesia 1992; 47: 20–23.Google Scholar
Shibata Y, Okamoto K, Matsumoto M, Suzuki K, Sadanaga M, Morioka T. Cardiovascular responses to fiberoptic intubation: a comparison of orotracheal and nasotracheal intubation. J Anesth 1992; 6: 262–268.Google Scholar
Smith JE. Heart rate and arterial pressure changes during fibreoptic tracheal intubation under general anesthesia. Anaesthesia 1988; 43: 629–632.Google Scholar
Roth AG, Wheeler M, Stevenson GW, Hall SC. Comparison of a rigid laryngoscope with the ultrathin fibreoptic laryngoscope for tracheal intubation in infants. Can Anesth J 1994; 41: 1069–1073.Google Scholar
Xue FS, Zhang GH, Sun HT et al. A comparative study of haemodynamic responses to orotracheal intubation with fiberoptic bronchoscope and laryngoscope in children. Pediatr Anesth 2006; 16: 283–289.Google Scholar
Kovac AL. Controlling the hemodynamic response to laryngoscopy and endotracheal intubation. J Clin Anesth 1996; 8: 63–79.Google Scholar
Yamagushi H, Tanaka H, Adachi K, Mino M. Beat to beat blood pressure and heart rate responses to active standing in Japanese children. Acta Paediatr 1997; 85: 577–583.Google Scholar
Piccirillo G, Cacciafesta M, Viola E et al. Influence of aging on cardiac baroreflex sensitivity determined non-invasively by power spectral analysis. Clin Sci 2001; 100: 267–274.Google Scholar
Gregory GA. The baroresponses of preterm infants during halothane anaesthesia. Can Anaesth Soc J 1982; 29: 105–107.Google Scholar
Wear R, Robinson S, Gregory GA. The effect of halothane on the baroresponse of adult and baby rabbits. Anesthesiology 1980; 56: 188–191.Google Scholar
Constant I, Abbas M, Boucheseiche S, Laude D, Murat I. Non-invasive assessment of cardiovascular autonomic activity induced by brief exposure to 50% nitrous oxide in children. Br J Anaesth 2002; 88: 637–643.Google Scholar
Ebert TJ. Differential effects of nitrous oxide on baroreflex control of heart rate and peripheral sympathetic nerve activity in humans. Anesthesiology 1990; 72: 16–22.Google Scholar
Xue FS. Tracheal tube. In: Xue FS, ed. Modern Airway Management—Critical Procedure for Anaesthesia and Intensive Care (Chinese). Zhengzhou, China: Zhengzhou University Publishing House, 2002: 270–272.
Hannallah RS, Baker SB, Casey W et al. Propofol: effective dose and induction characteristics in unpremedicated children. Anesthesiology 1991; 74: 217–219.Google Scholar
Xue FS, Tong SY, Liu QH. The total propofol total intravenous anesthesia in children. J Clin Anesthesiol (Chinese) 1998; 14: 96–97.Google Scholar
Manschot HJ, Meursing AE, Axt P, Byttebier GO, Erdmann W. Propofol requirements for induction of anesthesia in children of different age groups. Anesth Analg 1992; 75: 876–879.Google Scholar
Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiology 1994; 81: 1005–1043.Google Scholar
Wu AS, Yue Y, Wu QW, Lu GY. The changes of BIS, SEF, HRV and hemodynamics following induction with propofol and fentanyl in adults and children. Forum Anesth Mon (Chinese) 2003; 10: 425–427.Google Scholar
Billard V, Moulla F, Bourgain JL, Megnigbeto A, Stanski DR. Hemodynamic response to induction and intubation. Propofol/fentanyl interaction. Anesthesiology 1994; 81: 1384–1393.Google Scholar
Pernerstorfer T, Krafft P, Fitzgerald RD et al. Stress response to tracheal intubation: direct laryngoscopy compared with blind oral intubation. Anaesthesia 1995; 50: 17–22.Google Scholar
Short SM, Aun ST. Haemodynamic effects of propofol in children. Anaesthesia 1991; 46: 783–785.Google Scholar
Borgeat A, Fuchs T, Tassonyi E. Induction characteristics of 2% propofol in children. Br J Anaesth 1997; 78: 433–435.Google Scholar
Sellgren J, Ponten J, Wallin BG. Percutaneous recording of muscle nerve sympathetic activity during propofol, nitrous oxide, and isoflurane anesthesia in humans. Anesthesiology 1990; 73: 20–27.Google Scholar
Aun CS, Sung RY, O'Meara ME, Short TG, Oh TE. Cardiovascular effects of i.v. induction in children: comparison between propofol and thiopentone. Br J Anaesth 1993; 70: 647–653.Google Scholar
Lennander O, Henriksson BA, Martner J, Biber B. Effects of fentanyl, nitrous oxide, or both, on baroreceptor reflex regulation in the cat. Br J Anaesth 1996; 77: 399–403.Google Scholar
Kortly KJ, Ebert TJ, Vucins EJ, Roerig DL, Stadnicka A, Kampine JP. Effects of fentanyl-diazepam-nitric oxide anaesthesia on arterial baroreflex control of heart rate in man. Br J Anaesth 1986; 58: 406–414.Google Scholar
Skovsted P, Sapthavichaikul S. The effects of isoflurane on arterial pressure, pulse rate, autonomic nervous activity, and barostatic reflexes. Can Anaesth Soc J 1977; 24: 304–314.Google Scholar
Todres ID, Gronin JH. Growth and development. In: Todres ID et al., eds. A Practice of Anesthesia for Infants and Children, 3rd edn. Philadelphia, Pennsylvania: W.B. Saunders Company, 2001: 15–16.
Riazi J. The difficult pediatric airway. In: Benumof JL, ed. Airway Management: Principles and Practice, 1st edn. Boston: Mosby, 1996: 587–589.
Takahashi S, Mizutani T, Miyabe M, Toyooka H. Hemodynamic responses to tracheal intubation with laryngoscope versus lightwand intubating device (Trachlight) in adults with normal airway. Anesth Analg 2002; 95: 480–484.Google Scholar
Parati G, Pomidossi G, Casadei R et al. Role of heart rate variability in the production of blood pressure variability in man. J Hypertens 1987; 5: 557–560.Google Scholar
Ebert TJ, Morgan BJ, Barney JA, Denahan T, Smith JJ. Effects of aging on baroreflex regulation of sympathetic activity in humans. Am J Physiol 1992; 263: H798–H803.Google Scholar
Ko SH, Kim DC, Han YJ, Song HS. Small-dose fentanyl: optimal time of injection for blunting the circulatory responses to tracheal intubation. Anesth Analg 1998; 86: 658–661.Google Scholar
De Fatima De Assuncao Braga A, Da Silva Braga FS, Poterio GM, Filier PR, Cremonesi E. The effect of different doses of propofol on tracheal intubating conditions without muscle relaxant in children. Eur J Anaesthesiol 2001; 18: 384–388.Google Scholar
Sims CH, Splinter WM. Fentanyl blunts the haemodynamic response of children to laryngoscopy. Can Anesth J 1990; 37: S91.Google Scholar