Document Detail

Cardiovascular changes after the three stages of nasotracheal intubation.
MedLine Citation:
PMID:  14570788     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Nasotracheal intubation typically comprises three distinct stages: (i) nasopharyngeal intubation; (ii) direct laryngoscopy to identify the vocal cords; and (iii) the passage of the tracheal tube into the trachea. The aim of this study was to identify and compare the cardiovascular responses associated with each of these stages. METHODS: Seventy-five ASA I or II patients, aged 16-65 yr, requiring nasotracheal intubation as part of their anaesthetic management, received a standardized general anaesthetic and were allocated randomly to receive either nasopharyngeal intubation or nasopharyngeal intubation plus direct laryngoscopy or full nasotracheal intubation. RESULTS: There was a significant hypertensive response, compared with pre-induction levels, in all three groups. The maximum mean (SD) mean arterial pressure in the nasotracheal intubation group was 113 (17.1) mm Hg, which was significantly greater than that in the nasopharyngeal intubation (97 (13) mm Hg) (P<0.001) and in the nasopharyngeal intubation plus laryngoscopy (103 (10.3) mm Hg) (P=0.007) groups. There was no significant difference between the nasopharyngeal intubation and nasopharyngeal intubation plus laryngoscopy groups (P=0.206). A similar pattern was seen for both systolic and diastolic arterial pressure. Nasotracheal intubation caused a significant increase in maximum mean (SD) heart rate, compared with pre-induction values, whereas the other two groups caused significant falls. The heart rate in the nasotracheal intubation group (92 (16.5) beats min(-1)) was significantly greater than in the other two groups (74 (8.6) (P<0.001) and 76 (12) (P<0.001) beats min(-1) respectively). There was no significant difference in heart rates between the nasopharyngeal intubation and nasopharyngeal intubation plus laryngoscopy groups (P=0.420). CONCLUSIONS: Nasopharyngeal intubation causes a significant pressor response. Stimulation of the larynx and trachea by the passage of the tracheal tube, but not direct laryngoscopy, causes a significant increase in this response.
S Singh; J E Smith
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  British journal of anaesthesia     Volume:  91     ISSN:  0007-0912     ISO Abbreviation:  Br J Anaesth     Publication Date:  2003 Nov 
Date Detail:
Created Date:  2003-10-22     Completed Date:  2003-11-17     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372541     Medline TA:  Br J Anaesth     Country:  England    
Other Details:
Languages:  eng     Pagination:  667-71     Citation Subset:  IM    
Department of Anaesthesia, University Hospital Birmingham, Selly Oak Hospital, Birmingham B29 6JD, UK.
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MeSH Terms
Anesthesia, General
Blood Pressure*
Heart Rate*
Intubation, Intratracheal / methods*
Middle Aged
Nasal Cavity
Oral Surgical Procedures

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