Cardiovascular response and backward, upward, right push maneuver during laryngoscopy: comparison between CMAC® video laryngoscopy and conventional Macintosh
Abstract: Increased blood
pressure and heart rate are the most frequent response to laryngoscopy which
sometimes causes serious complications. Laryngoscopy technique and tools modification
lessen the nociceptive stimulation, thus preventing hemodynamic response. BURP
maneuver is used to lower Cormack-Lehane level, but it can cause additional
pain stimulation during laryngoscopy. The aim of this study was to compare the
cardiovascular response and the need of BURP maneuver during laryngoscopy
between CMAC® and conventional Macintosh.
Methods: A randomized, single blinded, control trial was performed to 139
subjects who underwent general anesthesia with endotracheal tube. Subjects were
randomised into a control group (conventional Macintosh) and an intervention
group (CMAC®). The cardiovascular parameters (systolic, dyastolic, mean
arterial pressure, and heart rate) were measured prior to induction (T1).
Midazolam 0.05 mg/kg and Fentanyl 2 micrograms/kg were given 2 minutes before
the induction. Moreover, they were given propofol 1 mg/kg followed by propofol
infusion of 10 mg/kg/hour and Atracurium 0.8–1 mg/kg. After TOF-0
cardiovascular parameters (T2) were remeasured, it was proceeded to
laryngoscopy. When Cormack-Lehane 1–2 was reached (with or without BURP
maneuver), cardiovascular parameters were measured again (T3).
Results: Unpaired T-test showed that cardiovascular response during
laryngoscopy were significantly lower in the intervention group compared to the
control group (p<0.05). The need of BURP maneuver was significantly lower in
the CMAC® group compared to the Convensional Macintosh group (13.9% vs 40.3%;
p<0.05).
Conclusion: Cardiovascular response and BURP maneuver during laryngoscopy
with CMAC® were significantly lower compared to conventional Macintosh.
Keywords: BURP maneuver;
cardiovascular response; CMAC®; conventional Macintosh; laringoscopy
Author: Arif H.M. Marsaban,
Aldy Heriwardito, I G.N.A.D. Yundha
Journal Code: jpkedokterangg170197
