Incidence of transient sinus pause in cardiac rhythm increases with the use of hyperangulated videolaryngoscope blade compared to standard angle blade during tracheal intubation: A prospective randomised controlled trial.

Background: The hyperanglulated videolaryngoscope blade may exert different forces on the larynx compared to the standard angle blade, potentially leading to haemodynamic changes, particularly in cardiac rhythm.

Objective: This study aimed to investigate the impact of the hyperangulated blade on haemodynamic changes during tracheal intubation.

Design: A prospective randomised controlled trial.

Setting: Tertiary, university hospital, single centre.

Patients: A total of 134 patients scheduled for general anaesthesia were included in the final analysis.

Intervention: Tracheal intubation using either a standard angle videolaryngoscope blade (Standard group) or a hyperangulated blade (Hyperangulated group).

Main outcome measures: The occurrence of a transient decrease in heart rate or a transient sinus pause during tracheal intubation was recorded.

Results: The incidence of transient sinus pause was significantly higher in the Hyperangulated group compared to the Standard group (19% vs. 4%, respectively, P = 0.009). The percentage of the glottic opening score was significantly higher, and the incidence of backward, upward, and rightward pressure was significantly lower in the Hyperangulated group. The incidences of direct epiglottis lifting was significantly higher in the Hyperangulated group, and the total length of time of the blade in the mouth was significantly longer in the Hyperangulated group. Multivariate logistic analysis identified the use of a hyperangulated blade as an independent predictor of transient sinus pause during tracheal intubation (odds ratio = 5.73, 95% confidence interval = 1.53 to 21.53; P = 0.010).

Conclusion: The hyperangulated videolaryngoscope blade is associated with a higher incidence of transient sinus pause than the standard angle blade during tracheal intubation.

Trial registration: Clinical Research Information Service. Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare (Republic of Korea). (Identifier: KCT0006534). Online address: http://cris.nih.go.kr.