Haemodynamic response at double lumen bronchial tube placement Airtraq vs. MacIntosh laryngoscope, a randomised controlled trial

Introduction: Tracheal intubation causes a haemodynamic response that might be harmful for patients. The Airtraq (R) laryngoscope has been shown to decrease the haemodynamic response to single-lumen tube intubation. We hypothesised that double-lumen bronchial tube placement with the Double-lumen Airtraq (R) laryngoscope would cause a reduced haemodynamic response and decreased catecholamine release compared with the MacIntosh laryngoscope. Methods: Forty adult patients were randomly assigned to the Airtraq (R) group or to the MacIntosh group. Intubation with either the Airtraq (R) or the MacIntosh laryngoscope was performed two minutes after standardised induction of anaesthesia. Arterial blood pressure, heart rate, catecholamine levels, bispectral index and duration of the intubation procedure were measured. Results: Mean (standard deviation [95% confidence interval]) systolic arterial blood pressure at laryngoscopy with the Airtraq (R) laryngoscope was 124 (34 [106 to 141]) mmHg and, with the MacIntosh laryngoscope, it was 110 (25 [99 to 122]) mmHg (p = 1.0). Heart rate at laryngoscopy with the Airtraq (R) laryngoscope was 75 beats min-1 (16 [67 to 83]) and, with the MacIntosh laryngoscope, it was 64 beats . min-1 (14 [58 to 71]) (p = 0.71). Adrenaline levels post-intubation were 54.3 ng . l-1 (41.5) [29.3 to 79.4] in the Airtraq r group and 30.5 ng . l-1 (25.6) [15.1 to 46.0] in the MacIntosh group (p = 0.016). The duration of intubation with the Airtraq r laryngoscope was 88 s (31 [72-104]) while, with the MacIntosh laryngoscope, the duration was 75 s (35 [59-92]) (p = 0.26). Conclusions: The use of the Double-lumen Airtraq (R) laryngoscope provides no benefit regarding stress response compared to the MacIntosh laryngoscope.