A Double Blind Comparative Study on the Hemodynamic Parameters in Response to Insertion of Laryngeal Mask Airway and Endotracheal Intubation in Children Undergoing Elective Surgeries
Journal Title: Indian Journal of Anesthesia and Analgesia - Year 2017, Vol 4, Issue 4
Abstract
Background: Airway management is of one of most important task during delivery of general anaesthesia. It was then established that laryngotracheal stimulation can lead to sympatho adrenal stimulation. This can cause a sudden rise in blood pressure leading to left ventricular failure, cerebral haemorrhage and myocardial ischemia. In normotensive patients laryngoscopy and insertion of an endotracheal tube is immediately followed by an average increase of mean arterial pressure of 25 mm Hg. There is no evidence that this effect causes lasting damage in normotensive patients. It was concluded that the use of the laryngeal mask airway (LMA) may therefore offer few advantages than tracheal intubation in the anaesthetic management of patients where the avoidance of pressor response is of particular concern. Objective: 1. To determine the pressor response elicited by laryngoscopy and endotracheal intubation in ASA I and ASA II patients, undergoing elective surgeries. 2. To determine the pressor response elicited by laryngeal mask insertion in ASA I and ASA II patients, undergoing elective surgeries. 3. To study the difference between the pressor response seen with ETT and that seen with LMA in patients undergoing elective surgeries. Methods: A hospital based prospective randomized study was conducted to determine the haemodynamic response elicited by laryngoscopy and endotracheal intubation and we compared the response with that elicited by laryngeal mask insertion in ASA I and ASA II patients, listed for elective surgeries. Either an ETT or LMA was inserted after induction of anaesthesia. Evaluations included measurement of heart rate and blood pressure before insertion, after insertion of device, 1 minute, 3 minutes and 5 minutes after insertion.Results: In a prospective randomized trial, 60 ASA I and II children weighing between 8 to 45 kg in the range of 2 to 14 years of age, planned for elective surgery were randomly allocated to one of the two groups of 30 patients each. The change in pressor response was significantly higher in endotracheal intubation children as compared to LMA placement. Furthermore these changes persisted for longer duration in children with endotracheal intubation in comparison to LMA insertion (5 min vs 3 min). Conclusion: LMA can be routinely used as a safe and effective alternative airway device to endotracheal intubation for positive pressure ventilation in pediatric patients’ listed for elective surgical procedure.
Authors and Affiliations
Asha Patil
Keywords
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- EP ID EP472300
- DOI 10.21088/ijaa.2349.8471.4417.14
- Views 80
- Downloads 0
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