Endotracheal intubation with a lightwand or a laryngoscope results in similar hemodynamic variations in patients with coronary artery disease

  • Félix R. Monte
  • Juan C. Giraldo
  • Luis A. Betancur
  • José D. Rincón
  • Ismael E. Rincón
  • María V. Vanegas
  • Hernán Charris
Cardiothoracic Anesthesia, Respiration and Airway



To asses the cardiovascular changes after either lightwand or conventional laryngoscopic endotracheal intubation (EI) in patients with coronary artery disease.


Following Institutional approval and informed consent, 80 consecutive patients undergoing elective coronary artery bypass grafting were enrolled in this prospective, controlled, single-blinded study. General anesthesia was induced with fentanyl 5 μ·kg−1 and thiopental 5 mg·kg−1 followed by pancuronium 0.1 mg·kg−1. After loss-of-eyelash reflex the lungs were manually ventilated with 2% isoflurane in oxygen for five minutes. Patients were then randomly allocated to receive either the lightwand (lightwand group,n = 41) or direct-vision laryngoscopy (laryngoscopy group,n = 39). Heart rate (HR) and direct blood pressure were recorded before induction, after induction but before EI, during EI, immediately after EI and at ten-second intervals for the following five minutes. Hemodynamic management during induction was standardized. Hypotension was treated with volume replacement, ephedrine, or phenylephrine as indicated; hypertension was treated withiv nitroglycerin; tachycardia was treated with boluses of esmolol; and, bradycardia was treated with atropine or ephedrine.


In both groups, mean arterial blood pressures and HR increased significantly after EI. There was a tendency for the light-wand group to have lower arterial blood pressures and slower HR. However, the differences between the two groups did not reach statistical significance. Requirements for drugs to control HR and mean arterial pressure were similar in both groups.


In patients with coronary artery disease using a light-wand intubation technique does not modify the hemodynamic response associated with EI as compared with standard direct-vision laryngoscopy.


Tracheal Intubation Endotracheal Intubation Mean Arterial Blood Pressure Esmolol Coronary Artery Bypass Grafting Patient 
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L’intubation endotrachéale avec stylet lumineux ou laryngoscope produit des variations hémodynamiques comparables chez des malades atteints de cardiopathie ischémique



Évaluer les modifications cardiovasculaires suivant l’intubation endotrachéale (IE) avec un stylet lumineux ou un laryngoscope traditionnel chez des malades atteints de cardiopathie ischémique.


Ayant reçu l’approbation de l’institution et le consentement éclairé des participants, nous avons recruté 80 patients consécutifs, qui devaient subir un pontage aortocoronarien, pour notre étude prospective, contrôlée et à simple insu. L’anesthésie générale a été induite avec 5 μg·kg−1 de fentanyl et 5 mg·kg−1 de thiopental, suivis de 0,1 mg·kg−1 de pancuronium. Après la perte du réflexe ciliaire, les poumons ont été ventilés manuellement avec de l’isoflurane à 2% dans de l’oxygène pendant cinq minutes. Les patients ont été répartis au hasard pour l’intubation avec le stylet lumineux (n =41) ou par laryngoscopie à vision directe (n = 39). La fréquence cardiaque (FC) et la tension artérielle (TA) directe ont été enregistrées avant l’induction, après l’induction mais avant l’IE, pendant l’IE, immédiatement après l’IE et à 10s d’intervalle pendant les cinq minutes suivantes. La prise en charge hémodynamique a été normalisée pendant l’induction. L’hypotension a été traitée par remplissage vasculaire, éphédrine, ou phényléphrine selon l’indication; l’hypertension, par nitroglycérine iv; la tachycardie, par de l’esmolol en bolus et la bradycardie, par de l’atropine ou de l’éphédrine.


Dans les deux groupes, les tensions artérielles moyennes (TAM) et la FC ont significativement augmenté après l’IE. Dans le groupe d’intubation au stylet lumineux, les TA avaient tendance à baisser et la FC à ralentir. Cependant, les différences intergroupes n’étaient pas statistiquement significatives. Les besoins de médicaments pour contrôler la FC et la TAM ont été similaires dans les deux groupes.


Chez les malades atteints de cardiopathie ischémique, l’intubation avec un stylet lumineux, comparée à la laryngoscopie traditionnelle à vision directe, ne modifie pas la réponse hémodynamique associée à l’IE.


  1. 1.
    Stoelting RK. Circulatory changes during direct laryngoscopy and tracheal intubation. Influence of duration of laryngoscopy with or without prior lidocaine. Anesthesiology 1977; 47: 381–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Ebert JP, Pearson JD, Gelman S, Harris C, Bradley EL. Circulatory responses to laryngoscopy: the comparative effects of placebo, fentanyl and esmolol. Can J Anaesth 1989; 36: 301–6.PubMedGoogle Scholar
  3. 3.
    Stone DJ, Gal TJ. Airway management.In: Miller RD (Ed.) Anesthesia, 5th ed. New York: Churchill Livingstone Inc.; 2000: 1444–6.Google Scholar
  4. 4.
    Hung OR, Pytka S, Morris I, et al. Clinical trial of a new lightwand device (Trachlight) to intubate the trachea. Anesthesiology 1995; 83: 509–14.PubMedCrossRefGoogle Scholar
  5. 5.
    Hung OR, Pytka S, Morris I, Murphy M, Stewart RD. Lightwand intubation: II-clinical trial of a new lightwand for tracheal intubation in patients with difficult airways. Can J Anaesth 1995; 42: 826–30.PubMedGoogle Scholar
  6. 6.
    Montes FR, Sanchez SI, Giraldo JC, et al. The lack of benefit of tracheal extubation in the operating room after coronary artery bypass surgery. Anesth Analg 2000; 91: 776–80.PubMedCrossRefGoogle Scholar
  7. 7.
    Knight RG, Castro T, Rastrelli AJ, Maschke S, Scavone JA. Arterial blood pressure and heart rate response to lighted stylet or direct laryngoscopy for endotracheal intubation. Anesthesiology 1988; 69: 269–72.PubMedCrossRefGoogle Scholar
  8. 8.
    Casati A, Aldegheri G, Fanelli G, et al. Lightwand intubation does not reduce the increase in intraocular pressure associated with tracheal intubation. J Clin Anesth 1999; 11: 216–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Hirabayashi Y, Hiruta M, Kawakami T, et al. Effects of lightwand (Trachlight) compared with direct laryngoscopy on circulatory responses to tracheal intubation. Br J Anaesth 1998; 81: 253–5.PubMedGoogle Scholar
  10. 10.
    Friedman PG, Rosenberg MK, Lebenbom-Mansour M. A comparison of light wand and suspension laryngoscopic intubation techniques in outpatients. Anesth Analg 1997; 85: 578–82.PubMedCrossRefGoogle Scholar
  11. 11.
    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: 480–4.PubMedCrossRefGoogle Scholar
  12. 12.
    Nishikawa K, Omote K, Kawana S, Namiki A. A comparison of hemodynamic changes after endotracheal intubation by using the Lightwand device and the laryngoscope in normotensive and hypertensive patients. Anesth Analg 2000; 90: 1203–7.PubMedCrossRefGoogle Scholar
  13. 13.
    O’Connor JP, Ramsay JG, Wynands JE, Kaplan JA. Anesthesia for myocardial revascularization.In: Kaplan JA (Ed.). Cardiac Anesthesia, 3th ed. Philadelphia: W.B. Saunders Company; 1993: 587–628.Google Scholar
  14. 14.
    Milocco I, Lof BA, William-Olsson G, Appelgren LK. Haemodynamic stability during anaesthesia induction and sternotomy in patients with ischaemic heart disease. A comparison of six anaesthetic techniques. Acta Anaesthesiol Scand 1985; 29: 465–73.PubMedGoogle Scholar
  15. 15.
    Atlee JL, Dhamee MS, Olund TL, George V. The use of esmolol, nicardipine, or their combination to blunt hemodynamic changes after laryngoscopy and tracheal intubation. Anesth Analg 2000; 90: 280–5.PubMedCrossRefGoogle Scholar
  16. 16.
    Takita K, Morimoto Y, Kemmotsu O. Tracheal lidocaine attenuates the cardiovascular response to endotracheal intubation. Can J Anesth 2001; 48: 732–6.PubMedGoogle Scholar
  17. 17.
    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: 658–61.PubMedCrossRefGoogle Scholar
  18. 18.
    Splinter WM, Cervenko F. Haemodynamic responses to laryngoscopy and tracheal intubation in geriatric patients: effects of fentanyl, lidocaine and thiopentone. Can J Anaesth 1989; 36: 370–6.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Félix R. Monte
    • 1
  • Juan C. Giraldo
    • 1
  • Luis A. Betancur
    • 1
  • José D. Rincón
    • 1
  • Ismael E. Rincón
    • 1
  • María V. Vanegas
    • 1
  • Hernán Charris
    • 1
  1. 1.Department of AnesthesiologyFundación Cardio Infantil - Instituto de Cardiología, Universidad del RosarioBogotáSouth America

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