• Michal Barak, Avishai Ziser, Avital Greenberg, Sophie Lischinsky, and Beno Rosenberg.
• Department of Anesthesiology, Rambam Medical Center, Haifa, Israel.
• J Clin Anesth. 2003 Mar 1;15(2):132-6.

Study ObjectiveTo compare the stress response following tracheal intubation using direct laryngoscopy to that using fiberoptic bronchoscopy technique.DesignRandomized, prospective study.SettingOperating rooms in a teaching hospital.Patients51 ASA physical status I and II patients who were scheduled for an elective surgery with general anesthesia.InterventionsPatients were randomly assigned to receive either direct laryngoscopy or fiberoptic orotracheal intubation, as part of general anesthesia. A uniform protocol of anesthetic medications was used.MeasurementsBlood pressure and heart rate were measured before induction, before endotracheal intubation, and 1, 2, 3, and 5 minutes afterwards. Catecholamine (epinephrine and norepinephrine) blood samples were drawn before the induction, and 1 and 5 minutes after intubation.Main ResultsDuration of intubation was shorter in the direct laryngoscopy group (16.9 (16.9 +/- 7.0 sec, range 8 to 40) compared with the fiberoptic intubation group (55.0 +/- 22.5 sec, range 29 to 120), p < 0.0,001. In both groups, blood pressure and heart rate were significantly increased at 1, 2, and 3 minutes after intubation, but there was no significant difference between the two study groups. Catecholamine levels did not increase after intubation and did not correlate with the hemodynamic changes.ConclusionsThe use of either direct laryngoscopy or fiberoptic bronchoscopy produces a comparable stress response to tracheal intubation. Catecholamine levels do not correlate with the hemodynamic changes.

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