Effect of fiberoptic intubation on myocardial ischemia and hormonal stress response in diabetics with ischemic heart disease

Abstract

Background: Diabetic patients with ischemic heart disease can greatly benefit from decreasing the stress response to intubation with its metabolic sequelae. The use of fiberoptic bronchoscopy will eliminate the response to direct laryngoscopy while lubrication of ETT with lidocaine gel 2% will decrease the response to endotracheal intubation. This study was conducted to compare the stress response hormones (glucose, cortisol and c-peptide) and the hemodynamic responses to intubation between direct laryngoscopy and fiberoptic bronchoscopy in diabetic ischemic patients. Patients and methods: Forty-four adult diabetic patients with ischemic heart disease, ASA II, with a blood glucose level between 120 and 180 mg/dL, requiring orotracheal intubation under general anesthesia were divided into 2 equal groups. The laryngoscopic group (n = 22) and the fiberoptic group (n = 22). Ovassapian airway was used to facilitate fiberoptic intubation with avoidance of jaw thrust maneuver. Blood glucose, cortisol and c-peptide were recorded before induction and 10 min after intubation and compared between both groups. The hemodynamic parameters were recorded and compared between both groups. Automated ST segment monitoring was used to detect ischemia. Results: There was statistically significant increase in HR, SBP and DBP in laryngoscopic group than in fiberoptic group. However, the incidence of ECG ST-segment changes was comparable with no statistically significant difference between groups. There were no statistically significant differences regarding glucose, cortisol and c-peptide levels between the study groups pre and post-induction. The intubation time in the fiberoptic group showed a statistically significant increase in comparison with the laryngoscope group (39 ± 12.04 vs. 29.3 ± 8.54 s; P < 0.05). Conclusion: The optimum use of fiberoptic bronchoscope with avoidance of jaw thrust maneuver attenuates the hemodynamic response to intubation which is beneficial in diabetic patients with ischemic heart disease. Stress response hormones showed no statistically significant difference between groups.

Keywords

• Fiberoptic
• Stress response
• Cortisol
• Glucose
• c-Peptide