الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
.Endotracheal intubation can lead to hypertension, tachycardia and various forms of arrhythmias. The cardiovascular response to intubation can be tolerated by normal fit patients but they may be hazardous in critically ill patients specially those with hypertension and ischemic heart disease.
Fiberoptic intubation is a well established technique for endotracheal intubation. We studied the effect of rigid laryngoscopy, fiberoptic endoscopy for oral and nasal intubation and the effect of different methods of attenuation of intubation response. Therefore, Our study presents the comparison of cardiovascular responses between the conventional tool with or without superior laryngeal nerve block and the fiberoptic endoscopy through the oral and nasal passage with and without superior laryngeal nerve block. where we used the bilateral superior laryngeal nerve block as a way for attenuating the airway responses to the intubation.
A hundred ASA physical status I and II patients, scheduled for elective surgical procedure. They were allocated into fives equal groups. The first group which was the control group in which the intubation was done by the conventional tool (rigid laryngoscopy). The second, in which the intubation was done by the conventional tool i.e laryngoscopy but preceded
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superior laryngeal nerve block. where as the third group and fifth group, the intubation was done by the fiberoptic endoscopy through the oral passage and nasal passage (as in group III and group V respectively). Through nasal fiberoptic endoscopy we did not use vasoconstrictor or topical xylocains. However the fourth group, the intubation was done orally by the fiberoptic endoscopy but preceded by bilateral superior laryngeal nerve block.
All the patients of the fives groups were premeditated before the operation in the transfer of the operating wheather with atropine 0.6 mg and 30 Mg/Kg dormicum intravenously before the induction of general anaesthesia with half an hour. Then the patients transferred to the operating theater for induction of general anaesthesia. where the induction of anaesthesiq was done by fetnayl 4 Mg/Kg, pavulon 0.1 mg/kg, thiopental sodium 4 mg/kg and 1.5 mg/kg xylocaine before the induction with three minutes. Then the intubation was done after 5 minutes of induction under 100% oxygen and 0.6% halothane with mask ventilation (i.e. manually).
All patients of the five groups, after the induction and just before the intubation, their cardiovascular responses regarding the mean systolic, mean diastolic and mean arterial pressure were reduced significantly than the pre induction values. But their pulse rate after the induction was rising insignificantly than the preinduction values. However, just before intubation
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the heart rate were decreased insignificantly than the preinduction values.
On the other hand, the effect of intubation response regarding to the cardiovascular variables was pronounced and elucited in the control group, the third group and the fifth group, after the intubation with 1 to 3 minutes. This pronounced effect started to decrease after 3 minutes of intubation time to reach the preinduction value or even be less.
However, the intubation response was attenuated as in group four, in which the intubation was done by oral fiberoptic intubation which preceded with bilateral S.L.N.B., regarding to mean s systolic and mean arterial pressure which decreased significantly till the end of the study, while the mean diastolic pressure was decreased but insignificantly. However, the superior laryngeal nerve block in the second group did not show any significant attenuation on the intubation response.
Whereas, the comparison between the control group and the other four groups regarding to the mean systolic pressure, mean diastolic and mean arterial pressure showed insignificant changes all through the time of the comparison, except the second group showed significant decrease after 5 and 10 minutes. But the third group showed a significant decrease after 10 minutes of intubation time. However, the fourth group showed significant reduction than the control significantly all
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through the time of the comparison. Whereas, the fifth group, it did not shown any significant changes than the control group.
But the comparison between the second group and the other groups showed insignificant changes regarding tot he cardiovascular variables all through the time of the comparison. Also, the comparison between the third group and the other grows showed insignificant changes regarding to the three cardiovascular variables all through the time of the comparison. Whereas, the comparison between the fourth and fifth group showed insignificant changes regarding to the cardiovascular variable all through the time of comparison, except after 1 and 3 minutes showed significant rising than the fourth group.
On other hand, the effect of intubation response on pulse rate showed insignificant rising which was elucited in the second and fifth groups. But, the control group and the fourth groups showed a significant rising than the control value for 1 to 2 minutes after the intubation, which then tended to decrease again after 3 minutes of intubation time. Whereas the third group showed a pronounced effect after the intubation with 1 minute and withstand till 5 minutes with a highly significant rising.
However, the cot iparison between the control group and the other groups regarding to mean pulse rate showed insignificant decrease during the time of the comparison, except
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in the second group, there were insignificant decrease than the control group after 3 and 10 minutes. but in the fifth group showed a highly significant decrease after 3 minutes of intubation time.
Whereas, the comparison between the second group and the other groups (III, IV and V) showed insignificant changes all through the time of the comparison. The same effect was pronounced during the comparison between the third group and the other groups (IV and V) insignificant changes. Also, the comparison between the fourth and fifth group showed insignificant changes all through the time of the comparison.
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In conclusion: The bilateral superior laryngeal nerve block with usage of oral fiberoptic intubation plays an important role in attenuation of the there haemodynamic variables. Whereas this method of the attenuating the airway reflexes during the intubation it doesn’t attenuate the pulse rate.
Inspite of the intubation by the conventional methods i.e. laryngoscope which preceded by bilateral superior laryngeal nerve block plays an effective role in the attenuating the pulse rate. On other hand, the intubation by fiberoptic endoscopy through the oral passager or nasal passager, it dose not making any difference effect on the haemodynamic variables in comparison to the oral intubation by the laryngoscope. But, the mean of pulse rate was rising obviously through the oral intubation by fiberoptic endoscope.