"A Prospective Randomized Control Study Comparing Hemodynamic Changes During Traditional Awake Extubation And Exchange Extubation Using Lma Supreme In Controlled Hypertensive Patients”
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 11
Abstract
Background And Aims: Patients with arterial hypertension generally exhibitexcessive pressor response to stresssuch as laryngoscopy ,intubation,surgical incision and extubation, which can lead to arrhythmias, myocardial ischemia and cerebrovascular accidents. Exchange extubation with LMA Supreme can be used to overcome or blunt the excessive pressor response following extubation.This study was aimed to compare the hemodynamic stress response between traditional awake extubation of the endotracheal tube (ETT) and that following exchange extubation of ETT by using a laryngeal mask airway (LMA Supreme) in terms of Post Extubation Heart Rate (H.R), Systolic Blood Pressure (S.B.P), Diastolic Blood Pressure (D.B.P), Mean Arterial Pressure (MAP) , to determine whether this method is easy to perform, the amount of experience needed to perform the exchange well and to calculate the time delay in extubation caused by adopting this method. Methods: The proposed study was carried out in S.R.N. Hospital associated with M.L.N. Medical College, Allahabad after approval from ethical committee and obtaining written and informed consent from the patient. After complete pre- anesthetic check-up and investigations.controlled hypertensive patients with ASA (American Society of Anaesthesiologists) grade II, between the age of 18 and 65 years, undergoing elective, non-oral surgery were included in the group. Results:On the basis of observations and statistical comparison followingconclusions were made: There was highly significant increase in pulse ratein Group A (ETT Group) as compare to LMA SupremeTMgroup, which was statistically significant till 15min. ofextubation. Statisticallysignificant increase in SBP was seen in Group A (ETT Group) which was statistically significant till 10th min. after extubation as compared to group B. Statistically significant increase in SBP in LMA supreme exchange groupwas not observed. Significant increase in DBP was seen in group A (ETT Group) which was statistically significant till 5 min. after extubation(p<0.0001). In group B, there was no significant rise in DBP aftet extubation till 15 min. Significant increase in MAP was seen in group A (ETT Group) in compare to LMA Supreme exchange group, which was statistically significant till 5min. after extubation(p<0.001). There were no fluctuations in MAP trend in the group B (LMA Supreme exchange group). It took more time for extubation in Group B as compared to Group A.(p=0.002). Conclusion: The comparative study showed LMA supreme exchange group has good results in terms of success of insertion, hemodynamic stability, adequate ventilation and less post-operative airway complication. Hence, it was concluded that LMA Supreme exchange extubationis suitable and a safe alternative to cuffed ETT for airway management in elective controlled hypertensive patients undergoing surgeries under general anaesthesia.
Authors and Affiliations
Dr A. K. Gupta, DrSumit Kumar, Dr SanniDeyol Gautam
Keywords
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- EP ID EP238335
- DOI 10.9790/0853-1611050106
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