Effect of SEEKflex-guided versus conventional intubation on hemodynamic responses in elderly hypertensive patients: a randomized controlled trial

Abstract

In elderly patients with preexisting cardiovascular and cerebrovascular diseases, laryngoscopy and tracheal intubation can provoke substantial hemodynamic disturbances, including hypertension and tachycardia, which may precipitate major cardiovascular or cerebrovascular events and even death. Therefore, the employment of a novel, safe, and straightforward intubation device is therefore of considerable clinical importance. To compare the effects of tracheal intubation guided by a novel tracheal tube kit (Safe Easy Endotracheal Kit-flexible; SEEKflex) versus a conventional stylet on hemodynamic parameters in elderly hypertensive patients during intubation. This prospective, randomized study was conducted from August 2024 to November 2024 and included 80 elderly hypertensive patients scheduled for elective surgery requiring oral tracheal intubation at our hospital. All patients had American Society of Anesthesiologists (ASA) physical status grades of II. Participants were randomly assigned, via a random number table, to one of two groups: the SEEKflex-guided intubation group (SEEKflex group) or the conventional stylet-shaped intubation group (Conventional group). Following intravenous induction of anesthesia, oral tracheal intubation was performed using the assigned device. Mean arterial pressure (MAP) and heart rate (HR) were recorded at T0 (before induction), T1 (after induction, before intubation), T2 (immediately after intubation), T3 (30 s after intubation), T4 (1 min after intubation), and T5 (3 min after intubation). Intubation time, first-attempt success rate, and incidence of intubation-related respiratory complications were also recorded. Following intubation, MAP and HR increased from post-induction levels in both groups. At T3 and T4, the SEEKflex group exhibited significantly lower MAP and HR than the Conventional group (P < 0.05). The first-attempt intubation success rate was higher in the SEEKflex group (P < 0.05), although intubation time was shorter in the Conventional group (23.69 ± 4.70 s vs. 33.80 ± 3.32 s, P < 0.05). No significant differences were observed in SpO₂ levels or rates of post-intubation complications between the two groups. The use of the SEEKflex for guiding tracheal intubation attenuates the hemodynamic response to intubation and improves hemodynamic stability in elderly hypertensive patients, compared with a conventional stylet. The SEEKflex may be a suitable option for tracheal intubation in this patient population during general anesthesia. ChiCTR2400087611 (Date: 2024.07.31) -Question: In elderly hypertensive patients undergoing tracheal intubation, does guidance with the SEEKflex device result in better hemodynamic stability compared to a conventional stylet? -Findings: Compared to conventional stylet-guided intubation, the use of SEEKflex significantly attenuated the increase in mean arterial pressure and heart rate at 30 s and 1-minute post-intubation and achieved a higher first-attempt success rate. -Meaning: The SEEKflex is a suitable option for tracheal intubation in elderly hypertensive patients as it mitigates the hemodynamic stress response and promotes perioperative cardiovascular stability.