Introduction: Endotracheal intubation is the commonest procedure done during general anaesthesia and it includes stressor response during the procedure. It is a challenging task to do it with minimal stress response. The purpose of our study was to find a better technique to assess the adequate intubating condition to reduce the stress response of endotracheal intubating procedure and hence we compared clinical assessment guided tracheal intubation and train of four (TOF) guided tracheal intubation and looked for the haemodynamic responses. Aim: To assess the haemodynamic responses of tracheal intubation guided via Train of Four (TOF) monitoring compared to tracheal intubation guided via clinical assessment. Method: In this prospective randomized clinical study, 70 adults, ASA -1 and ASA-2, MPG- 1 and MPG-2 undergoing elective surgery under general anaesthesia with tracheal intubation were allocated to two groups (n = 35) according to TOF guided (Group T) or Clinical assessment guided (Group C) tracheal intubation. Anaesthesia was induced with Inj.propofol 2mg/kg and after standardization of supramaximal stimulus, Inj.Vecuronium 0.1mg/kg was administered. In group T, trachea was intubated after TOF ratio became zero in Adductor Pollicis muscle, whereas in group C, trachea was intubated after clinical assessment of jaw muscle relaxation, airway tone and ease of ventilation. Changes in heart rate, mean arterial pressure, mean systolic blood pressure, mean diastolic blood pressure were recorded along with intubating conditions which were scored on a Kreig et al score. Results were analysed by Paired-t test and chi square test. Results: Heart rate, mean arterial pressure, mean systolic blood pressure and mean diastolic blood pressure were observed to be significantly higher in Group C compared to Group T (P<0.05). Excellent and good intubating conditions were found in both the groups. However, 91.43% excellent intubating conditions were found in Group T compared to 57.14% in Group C. Conclusion: Neuromuscular block monitoring of Adductor Pollicis muscle based endotracheal intubation can be a suitable, non-pharmacological method in assessing appropriate time of intubation, providing excellent intubating conditions hence significant attenuation of hemodynamic response to laryngoscopy and tracheal intubation.

Introduction: Endotracheal intubation is the commonest procedure done during general anaesthesia and it includes stressor response during the procedure. It is a challenging task to do it with minimal stress response. The purpose of our study was to find a better technique to assess the adequate intubating condition to reduce the stress response of endotracheal intubating procedure and hence we compared clinical assessment guided tracheal intubation and train of four (TOF) guided tracheal intubation and looked for the haemodynamic responses. Aim: To assess the haemodynamic responses of tracheal intubation guided via Train of Four (TOF) monitoring compared to tracheal intubation guided via clinical assessment. Method: In this prospective randomized clinical study, 70 adults, ASA -1 and ASA-2, MPG- 1 and MPG-2 undergoing elective surgery under general anaesthesia with tracheal intubation were allocated to two groups (n = 35) according to TOF guided (Group T) or Clinical assessment guided (Group C) tracheal intubation. Anaesthesia was induced with Inj.propofol 2mg/kg and after standardization of supramaximal stimulus, Inj.Vecuronium 0.1mg/kg was administered. In group T, trachea was intubated after TOF ratio became zero in Adductor Pollicis muscle, whereas in group C, trachea was intubated after clinical assessment of jaw muscle relaxation, airway tone and ease of ventilation. Changes in heart rate, mean arterial pressure, mean systolic blood pressure, mean diastolic blood pressure were recorded along with intubating conditions which were scored on a Kreig et al score. Results were analysed by Paired-t test and chi square test. Results: Heart rate, mean arterial pressure, mean systolic blood pressure and mean diastolic blood pressure were observed to be significantly higher in Group C compared to Group T (P<0.05). Excellent and good intubating conditions were found in both the groups. However, 91.43% excellent intubating conditions were found in Group T compared to 57.14% in Group C. Conclusion: Neuromuscular block monitoring of Adductor Pollicis muscle based endotracheal intubation can be a suitable, non-pharmacological method in assessing appropriate time of intubation, providing excellent intubating conditions hence significant attenuation of hemodynamic response to laryngoscopy and tracheal intubation.