HEMODYNAMIC CHANGES AFTER LARYNGOSCOPY IN PATIENTS UNDERGOING ELECTIVE SURGERY UNDER GENERAL ANESTHESIA AT DHQ HOSPITAL KURRAM; PROSPECTIVE DESCRIPTIVE OBSERVATIONAL STUDY

Abstract

Background:

Endotracheal intubation and laryngoscopy during general anesthesia cause significant hemodynamic changes due to sympathetic stimulation. Mechanical airway stimulation triggers catecholamine release, resulting in increased blood pressure and heart rate, which are usually transient but clinically important. This study evaluates these changes in elective surgical patients at district-level hospitals to improve perioperative safety.

Objectives:

• To assess changes in HR, SBP, DBP, and MAP following laryngoscopy in patients undergoing elective surgery under General Anesthesia.
• To determine the duration of hemodynamic changes at baseline, immediately after laryngoscopy, and at 1, 3, 5 and 10 minutes after endotracheal intubation.

Methodology:

Data were collected in a prospective descriptive observational study at DHQ Hospital, District Kurram (Parachinar) over 4–5 months, including elective surgical patients using a predesigned proforma. Demographic variables (age, gender, ASA status, type of surgery, weight) and hemodynamic parameters (HR, SBP, DBP, SpO₂, MAP) were recorded at baseline and at 1, 3, 5, and 10 minutes post-intubation. Additional data laryngoscope type, intubation attempts, and anesthetic agents were recorded and analyzed using SPSS version 22.

Results:

A total of 70 patients were enrolled, with a mean age of 32.6 ± 9.9 years; most were male (61.4%) and ASA I (77%). All patients were successfully intubated, 95.7% on the first attempt, with no cardiac disease; mean laryngoscopy duration was 22.6 ± 3.7 seconds. After induction, heart rate decreased from 85.7 ± 13.7 bpm to 74.2 ± 10.9 bpm, and systolic BP from 125.0 ± 8.4 mmHg to 114.6 ± 10.2 mmHg. At 1 mint post-intubation, significant increases were observed: HR 95.5 ± 10.2 bpm, SBP 139.3 ± 12.2 mmHg, DBP 89.4 ± 10.1 mmHg, MAP 105.6 ± 11.3 mmHg. By 3 minutes parameters declined, and by 5–10 minutes approached baseline (HR 81.9 ± 9.5 bpm, SBP 125.6 ± 8.8 mmHg, DBP 79.8 ± 7.0 mmHg, MAP 94.4 ± 7.8 mmHg).Repeated measures ANOVA showed highly significant changes (p < 0.001), with maintained oxygenation and no clinically significant desaturation.

Conclusion:

Laryngoscopy and endotracheal intubation in ASA I–II patients cause significant but transient hemodynamic responses, peaking at 1 minute and returning to baseline within 5–10 minutes. These changes are usually well tolerated in healthy individuals but require vigilant peri-intubation monitoring. Findings from this district-level study provide baseline data and emphasize careful airway management, especially in patients with cardiovascular risk.