Hemodynamic Responses to Endotracheal Intubation: A Comparison Between Bonfils Intubation Fiberscope and Direct Laryngoscopy

Background: Laryngoscopy and intubation are intensely stimulating procedures and can induce marked sympathetic responses. We hypothesized that by minimizing the oropharyngeal stimulus with Bonfils rigid fiberscope intubation, the hemodynamic responses to endotracheal intubation will be lesser. Therefore, we compared Bonfils intubation with conventional direct laryngoscopic intubation in adult patients with normal airway. Materials and Methods: Sixty adult patients of either sex, belonging to American Society of Anesthesiologists grade 1 or 2, were randomized into Bonfils group and laryngoscopy group, and studied over a 2‑year period. Anesthet ic technique was standardized in both the groups. Hemodynamic variables were recorded at pre‑induction, induction, post‑induction at laryngoscopy and intubation, thereafter for every minute for 10 min, and half hourly till the end of surgery for both the groups. Intubation time, intubation attempts, and postoperative complications like hoarse voice and sore throat were compared between the two groups. Results: There was no statistically significant difference between the two groups with respect to systolic blood pressure, mean blood pressure, and heart rate changes throughout the study period. There was a statistically significant difference in the diastolic blood pressure (DBP) values between the groups (P < 0.05) for the first 10 min following intubation. The time required for intubation was significantly longer in the Bonfils group (36 ± 6 s) compared to the laryngoscopy group (28 ± 6 s) (P = 0.000). The incidence of postoperative sore throat (P = 0.009) and hoarseness of voice (P = 0.045) was significantly lesser in the Bonfils group compared to the laryngoscopy group. Conclusion: There was no clinically significant difference in the hemodynamic changes following intubation using either Bonfils fiberscope or conventional laryngoscope. Bonfils intubation required longer time, but was associated with lesser incidence of sore throat and hoarseness of voice when compared to laryngoscopic intubation.