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A Randomised Comparative Interventional Prospective Study of Intubation by Macintosh Laryngoscope Versus McGrath Video Laryngoscope in Patients Undergoing Cardiac Surgery

Author(s): Indu Verma, Chandan Verma, Sandeep Dhaked, Ramnaresh Sharma

Background: Laryngoscopy and endotracheal intubation is an integral part of general anesthesia for cardiac surgery. Direct laryngoscopy and passage of endotracheal tube through the larynx is a noxious stimulus, which can provoke untoward response in the cardiovascular, respiratory and other physiological systems. Significant tachycardia and hypertension can occur with tracheal intubation under light anesthesia. In this study our aim was to evaluate hemodynamic changes during intubation by using Macintosh and McGrath video laryngoscope in patients undergoing cardiac surgeries.

Objective: Our aim was to evaluate hemodynamic changes during intubation by using, Macintosh and McGrath video laryngoscope in patients undergoing cardiac surgeries.

Material and method: A total of 60 patients were randomly allocated to two groups which were divided according to intubation with Macintosh (Group A, n=30) versus McGrath (Group B, n=30). Both groups were studied by using Edwards EV 1000 flowtrac monitor with hemodynamic variable eg. stroke volume (SV), stroke vol. variation (SVV), Systematic vascular resistance (SVR), Stroke vol. index (SVI), cardiac output (CO), cardiac index (CI), BP (blood pressure)&PR (pulse rate). Patient undergoing various cardiac surgeries were included with ASA grade III & IV. Patient’s having coagulation abnormalities, pre -existing haematological, metabolic, hepatic, respiratory, renal disease were excluded. Intubation with more than 2 attempts and difficult intubation were also excluded.

Result: In group A the mean intubation time was 17.17 ± 3.03 sec. and in group B mean intubation time was 21.13 ± 3.04 sec. Among two groups significant (P<0.05) difference was observed between them. In group B there was a decrease in SVV, SVI, MAP, CI, SBP at 15 minutes post intubation, which was statistically not significant (p-value >0.05).

Conclusion: Our study showed that there was a hemodynamic stability in both the groups undergoing various cardiac surgeries. But in Group B, there was less rise in the mean hemodynamic variables. It is advisable to use McGrath video laryngoscope for intubation in these patients to maintain hemodynamic stability.

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