Airway Management, Heart Rate, Tracheal Intubation
Conditions
Keywords
Laryngoscopy, Bradycardia, Microlaryngoscopy
Brief summary
This prospective observational study aims to determine, if an tracheal intubation-related decrease in heart rate is associated with intraoperative reflex bradycardia in patients undergoing microlaryngoscopy (MLS) in general anesthesia.
Detailed description
Small studies and case series reported precipitous bradycardia or even asystole due to reflex vagal activity during tracheal intubation and/or laryngoscopy attributable to a so called laryngocardiac reflex (reflex bradycardia); however, larger systematic trials are still lacking. For the purpose of MLS, ENT surgeons frequently apply suspension laryngoscopy (Kleinsasser laryngoscope) in order to visualize the glottis and to enable surgery. Severe bradycardia has been reported during MLS that has been suspected to be induced by reflex vagal activity possibly promoted by the superior laryngeal nerve. It is still unknown, which patients are at risk for relevant intraoperative bradycardia and moreover, which patients might benefit from preemptive measures such as prophylactic application of positive chronotropic drugs like atropine sulfate, epinephrine or glycopyrrolate. Predictive factors for MLS-induced intraoperative bradycardia have not systematically been investigated yet. In particularly, it is unknown, if patients that present with a preoperative tracheal intubation-related decrease in heart rate have a predisposition for intraoperative reflex bradycardia during MLS. This prospective observational study aims to determine, if an tracheal intubation-related decrease in heart rate is associated with intraoperative reflex bradycardia in patients undergoing microlaryngoscopy (MLS) in general anesthesia. Moreover, if we find a positive association, we further aim to determine the predictive value of intubation-relatd bradycardia.
Interventions
None listed
Sponsors
Universitätsklinikum Hamburg-Eppendorf
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients requiring general anesthesia with tracheal intubation for elective MLS * Age ≥ 18
Exclusion criteria
* Pregnant or breastfeeding women * Confirmed indications for awake fiberoptic intubation * Planned endotracheal intubation without deep anesthesia or neuromuscular blocking agents (e.g. awake videolaryngoscopy) * Patients at risk for pulmonary aspiration who qualify for rapid sequence induction * Cardiac pacemaker * Atrial fibrillation * Denial of consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative decrease of the heart rate | 1 hour | Continuous intraoperative ECG heart rate measurement (sample rate 1000 hz) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Application of atropine sulfate | 1 hour | Intraoperative application of atropine sulfate by the responsible anesthetist (yes/no) |
| Application of positive inotropic drugs | 1 hour | Intraoperative application of other positive inotropic drugs such as epinephrine by responsible anesthetist (yes/no) |
| Cardiac arrhythmias | 1 hour | Continuous intraoperative ECG arrhythmia detection and labeling (sample rate 1000 hz) |
| Intraoperative asystolia | 1 hour | Continuous intraoperative ECG QRS-complex detection (sample rate 1000 hz) |
| Application of catecholamines or vasoactive drugs | 1 hour | Intraoperative application of catecholamines or vasoactive drugs by responsible anesthetist (yes/no) |
| Adverse cardiocirulatory events | 1 hour | Intraoperative adverse cardiocirulatory events docuimented by the responsible anethetist |
| PACU stay | 8 hours | Length of stay in the postanesthesia care unit (PACU) |
| Hypotension | 1 hour | Intraoperative blood pressure measurement |
Countries
Germany
Outcome results
None listed