Published: 2018-04-25

Comparison of hemodynamic responses along with perfusion index to tracheal intubation with Macintosh and McCoy laryngoscopes

Vineet K. Choudhary, Bhawana Rastogi, V. P. Singh, Savita Ghalot, Vijay Dabass, Sameer Ashraf


Background: The McCoy Laryngoscope in comparison to macintosh laryngoscope requires less force for performing laryngoscopy and as a result may alter the associated hemodynamic response. Perfusion index (PI) is a noninvasive numerical value of peripheral perfusion obtained from a pulse oximeter.

Methods: A randomized prospective single blind comparative clinical study was conducted on 80 patients of ASA physical status I-II aged between 18 years to 58 years of either sex with body mass index (B.M.I) between 20 and 25 undergoing elective surgeries under general anesthesia. 80 patients were divided into 2 groups: Group A (n=40)- Tracheal Intubation with Macintosh Laryngoscope, Group B (n=40)-Tracheal Intubation with McCoy Laryngoscope. Blood Pressure (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) and heart rate (HR), oxygen saturation (SpO2) via pulse oximeter were monitored.

Results: The demographic profile showed no significant difference between the groups. Heart rate, systolic, diastolic and mean arterial pressure had highly significant difference in both groups. Perfusion index was statistically significant immediately post laryngoscopy and intubation till 4 mins. Immediately after laryngoscopy and intubation, the correlation between PI and MAP was statistically significant and it was a negative average to good correlation.

Conclusions: The McCoy laryngoscope elicits lesser haemodynamic response to laryngoscopy and tracheal intubation as compared to Macintosh laryngoscope in normotensive patients. Perfusion index can also serve as an additional parameter to assess hemodynamic response since it has good negative correlation with the mean arterial pressure.


Hemodynamic response, Laryngoscopy and intubation, Macintosh laryngoscope, McCoy laryngoscope, Perfusion inde

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Haidry MA, Khan FA. Comparison of hemodynamic response to tracheal intubation with Macintosh and McCoy Laryngoscopes. J Anesthesiology Clinical Pharmacol. 2013;29(2):196-9.

Montazari K, Naghibi K, Hashemi SJ. Comparison of hemodynamic changes after insertion of laryngeal mask airway, facemask and endotracheal intubation. Acta Med Iran. 2004;42:437-40.

Shribman AJ, Smith G, Achola KJ. Cardiovascular and Catecholamine responses to laryngoscopy with and without endotracheal endotracheal intubation. British J Anesthesia. 1987;59:295-9.

Carmen U, Casas JI, Merten A. Macintosh’s Laryngoscope. Anesthesiology. 2005;102(1):242.

Cook TM, Tuckey JP. A comparison between Macintosh and McCoy laryngoscope blades. Anesthesia. 1996;51:977-80.

Dorsch JA, Dorsh SE. Laryngoscopes. Understanding anesthesia equipment. 5th Ed. Philadelphia: Lippincott Williams and Wilkins;2008.

Atef HM, Fattah SA, Gaffer ME, Rahman AA. Perfusion index versus noninvasive hemodynamic parameters during insertion of i-gel, classical laryngeal mask airway and endotracheal tube. Indian J Anesthesia. 2013;57(2):156-62.

Hagar H, Church S, Mandadi G, Pulley D, Kurz A. The perfusion index measured by a pulse oximeter indicates pain stimuli in anesthetized volunteers. Anesthesiology. 2004;101:A514.

Bhosle P, Aphale S, Bansal M. A comparison of circulatory response to laryngoscopy and intubation with MacIntosh And McCoy blade. Internet J Anesthesiol. 2013;32:1.

Jitendra M, Sharma S, Katoch M, Gulati S, Gupta H. Comparison of hemodynamic response to tracheal intubation with Macintosh and McCoy laryngoscopes. J Evolution Medical Dental Sci. 2015;4(50):8676-84.

Russell WJ, Morris RG, Frewin DB, Drew SE. Changes in plasma catecholamine during endotracheal intubation. British J Anaesthesia. 1981;53:837-9.

Goldman JM, Petterson MT, Kopotic RJ, Barker SJ. Masimo signal extraction pulse oximetry. J Clinical Monitoring Computing. 2000;16:475-83.