Direct Laryngoscopy and Intubation Cause Significant Hypertensive Response in Head-Injured Patients

Laryngoscopy and tracheal intubation are associated with a hypertensive response, although the degree of response in head-injured patients has not been specifically studied. In this retrospective British study, investigators report the hemodynamic response to direct laryngoscopy and tracheal intubation for 97 head-injured patients who required prehospital airway management. All patients underwent rapid sequence intubation (RSI) with ketamine or etomidate induction and succinylcholine paralysis. Patients did not receive pretreatment with either lidocaine or an opioid. Hemodynamics were measured before initiation of RSI (median, 9 minutes before) and after confirmation of successful intubation (median, 1 minute after).

All hemodynamic measures…