DL vs. Fast Track Sympathetic Stimulation

[miloisstinky]

I always have believed, through my readings and lectures, that the greatest sympathetic stimulation is with the direct laryngoscopy, ("cold steal is the real deal"). My classmate begs to differ, and says the most stimulation is from the ETT passing thru and being settled in the vocal cords. This topic came up in discussion because of the fast track LMA, in which there is no actual DL, and therefore, I thought NO (or little) sympathetic stimulation. What do you think, and do you know of any research articles related to this topic?

My theory was the Fast Track was a great way to intubate fragile cardiac patients b/c of the lack of DL stimulation. I may be way off.

[versatile_kat]

I always have believed, through my readings and lectures, that the greatest sympathetic stimulation is with the direct laryngoscopy, ("cold steal is the real deal"). My classmate begs to differ, and says the most stimulation is from the ETT passing thru and being settled in the vocal cords. This topic came up in discussion because of the fast track LMA, in which there is no actual DL, and therefore, I thought NO (or little) sympathetic stimulation. What do you think, and do you know of any research articles related to this topic?

My theory was the Fast Track was a great way to intubate fragile cardiac patients b/c of the lack of DL stimulation. I may be way off.

Just a thought, but shouldn't the adequate frontloading of narcotic before induction in cardiac patients be sufficient to blunt the ANS response to DL?

It should be interesting to see what more experienced providers think in regards to LMA v DL ... I've used the LMA 5 times so far (first clinical residency) and DL around 15 times and haven't noticed an increase in the ANS response with the LMA.

Good topic milo!

[gaspassah]

i usually notice a significant rise in heart tone on the monitor during tracheal stimulation. however after i started using a higher amount of narcotic up to 5 cc's fent (when allowed) and lidocaine 1 mg/kg i dont see it as much. as for a cardiac induction, where i did hearts most patients got 20 ccs of fentanyl to offset the tachycardia from 10 mg pavulon, working in a few ccs of each until it was all given.

d