Circulatory Responses to Fiberoptic Intubation in Anesthetized Children: A Comparison of Oral and Nasal Routes
Fu S. Xue, Cheng W. Li, Kun P. Liu, Hai T. Sun, Guo H. Zhang, Ya C. Xu, Yi Liu
(Anesth Analg, 104:282-288, 2007)
Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
A notable difference in the circulatory responses to fiberoptic nasotracheal intubation (FNI) and fiberoptic orotracheal intubation (FOI) has been reported in previous studies. However, it is not known whether there is a clinically relevant difference in the circulatory responses to these 2 intubation methods in children. A randomized clinical study compared the arterial blood pressure and heart rate changes during FNI and FOI in 66 children, American Society of Anesthesiologists physical status I or II, aged 3 to 9 years, scheduled for elective plastic surgery. After induction of anesthesia with fentanyl, propofol, and vecuronium, fiberoptic intubation was performed. Noninvasive arterial blood pressure and heart rate readings were recorded before (baseline values) and after anesthesia induction (postinduction values), at intubation, and every minute for the first 5 minutes after intubation. The maximum values of arterial blood pressure and heart rate during the observation period were also recorded. The total intubation time was markedly longer in the FNI group than in the FOI group. Both FOI and FNI resulted in increases in arterial blood pressure and heart rate compared with the baseline and postinduction values. Arterial blood pressure and heart rate at intubation and after intubation and their maximum values during the observation periods were lower in the FNI group compared with the FOI group. The times needed to reach the maximum values of systolic blood pressure and heart rate were longer in the FNI group than in the FOI group, but the times required for recovery of systolic blood pressure and heart rate to postinduction values were shorter in the FNI group than in the FOI group. After intubation was accomplished, the times needed to reach the peak levels of systolic blood pressure and heart rate were not different between the 2 groups. Both FOI and FNI can cause circulatory responses in healthy anesthetized children, but circulatory responses toFNI were less and of shorter duration than those to FOI.