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Title: Comparison of Hemodynamic Changes after Intubation with Macintosh and McCoy Laryngoscopes–A Randomised Controlled Trial
Authors: Muhammad Awais Qarni, Salma Nisar, Fawad Alam, Tariq Mehmood, Mashooque Ali, Sarah Nisar
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2023
Volume: 73
Issue: 2
Language: English
DOI: 10.51253/pafmj.v73i2.7749
Keywords: Endotracheal intubationHemodynamicsLaryngoscopes
Objective: To compare hemodynamic changes (systolic blood pressure and pulse) after intubation with Macintosh and McCoy laryngoscopes.
Study Design: Randomised control trial (Clinicaltrials.gov: NCT05133375)
Place and Duration of Study: Combined Military Hospital, Jhelum Pakistan, from Apr to Oct 2021.
Methodology: A group of 272 patients reporting to the operation theatre were selected and divided into Group-A and B using the lottery method. All patients had ASA class I and II score and Mallampati score of I and II with no comorbid conditions. Macintosh laryngoscope was used in Group-A, and McCoy laryngoscope was used in Group-B. Before intubation, systolic blood pressure and pulse were measured, as well as 30 seconds, 2 minutes, and 3 minutes following intubation. In addition, a comparison of both groups regarding systolic blood pressure and pulse was made.
Results: The patients in the study had a mean age of 34.93±9.66 years. The increase (20%) in heart rate was significantly higher in the Macintosh-Group 23(16.9%), than in the McCoy-Group 8(4.4%), (p=0.001), and the 20% increase in systolic pressure was also found to be significantly higher in the Macintosh-Group as compared to the McCoy-Group, 26(19.1%) versus 8(6.6%), (p=0.002).
Conclusion: According to our research, using the McCoy blade is a safer mode of intubation in terms of the hemodynamic response.
To compare hemodynamic changes (systolic blood pressure and pulse) after intubation with Macintosh and McCoy laryngoscopes.
Randomised control trial conducted at Combined Military Hospital, Jhelum Pakistan, from Apr to Oct 2021. 272 patients with ASA class I and II and Mallampati score of I and II were randomly divided into two groups. Group A underwent intubation with a Macintosh laryngoscope, and Group B with a McCoy laryngoscope. Systolic blood pressure and pulse were measured before intubation and at 30 seconds, 2 minutes, and 3 minutes post-intubation.
graph TD
A[Patient Selection & Grouping] --> B[Pre-anaesthetic Evaluation];
B --> C[Baseline MeasurementsPulse, SBP];
C --> D[Preoxygenation & Medication];
D --> E[Induction & Muscle Relaxation];
E --> F[Laryngoscopy & Intubation];
F --> G[Post-Intubation Measurements Pulse, SBP at 30s, 2min, 3min];
G --> H[Data Analysis];
H --> I[Conclusion: McCoy vs. Macintosh];
The McCoy laryngoscope's design facilitates easier epiglottis lifting, potentially reducing the stress response compared to the Macintosh laryngoscope. The study's findings align with previous research indicating fewer hemodynamic changes with McCoy laryngoscopes.
A 20% increase in heart rate was significantly higher in the Macintosh group (16.9%) compared to the McCoy group (4.4%) (p=0.001). Similarly, a 20% increase in systolic pressure was significantly higher in the Macintosh group (19.1%) compared to the McCoy group (6.6%) (p=0.002).
The McCoy blade is a safer intubation method regarding hemodynamic response.
1. The study was conducted from April to October 2021. Confirmed by the text.
2. The sample size was 272 patients. Confirmed by the text.
3. A 20% increase in heart rate was significantly higher in the Macintosh group (16.9%) compared to the McCoy group (4.4%) (p=0.001). Confirmed by the text.
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