Pressor Response to Laryngeal Mask Airway Insertion versus Endotracheal Intubation in Standard Anesthetic Practice
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 6
Abstract
Background: Laryngeal mask airways (LMAs) are being used increasingly nowaday as an alternate option to endotracheal intubation, as it is less invasive and causes less discomfort in the post-operative period. In a few patients, the pressor response associated with laryngoscopy and tracheal intubation may be harmful. The LMA avoids the need for laryngoscopy and allows positive pressure ventilation of the lungs in appropriate patients. In this study pressor responses to LMA insertion versus endotracheal intubation in a standard anesthetic practice were observed and analyzed. Aim of the Study: The aim of the study was to compare the pressor responses to LMA insertion versus endotracheal intubation in standard anesthetic practice. Materials and Methods: A total of 60 patients undergoing general anesthesia for various surgical procedures were divided into 2 groups. Group - I ventilated with endotracheal intubation and Group - II with laryngeal airway mask. During pre-induction, post-induction, and at 1, 3, and 5 min, the following post-induction hemodynamic parameters were noted such as (1) heart rate (HR), (2) blood pressure - systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure using NIBP at different intervals such as (a) before induction, (b) after induction, (c) at laryngoscopy and endotracheal intubation or insertion of the laryngeal mask, (d) 1 min after endotracheal intubation or insertion of the laryngeal mask, (e) 3 min after endotracheal intubation or insertion of the laryngeal mask, and (f) 5 min after endotracheal intubation or insertion of the laryngeal mask, (3) oxygen saturation, and (4) adverse events, if encountered. All the observed parameters were presented in a tabular form, and appropriate statistical methods were applied to obtain the results. Observations and Results: Among 60 patients 16/30 (53.3%) in Group - I and 14/30 in Group - II (46.6%) were aged 21–30 years in Group II. The mean age and standard deviation in Group - I was 28.40 ± 9.16 and in Group - II it was 30.73 ± 7.26. In Group I there were 16/30 (53.4%) females and in Group - II there were 10/30 (33.4%) females. Similarly, males were 14/30 (46.4%) in Group - I and 20/30 (66.66%) in Group - II. Mean SBP was higher in group ETT (Group - I) as compared to group LMA (Group - II) at intubation, 1st min, and 3rd min after intubation or LMA insertion. There was significant increase in DBP in Group - I at ETT intubation or insertion of LMA in Group - II, at 1 and 3 min after intubation or insertion of LMA. Mean SBP was higher in group ETT as compared to group LMA at intubation, 1 min, and 3 min after intubation or LMA insertion. Conclusions: Pressor response to LMA insertion is much less than that of laryngoscopy and endotracheal intubation. Duration and magnitude of the pressor response are transient during LMA insertion. LMA may be useful in airway management during anesthesia in situations where marked pressor response would be deleterious, for example, patients with hypertension and coronary artery disease. However, large-scale studies are required to confidently ascertain the findings of present study.
Authors and Affiliations
L Giridhar Naik, Venkanna Pocham
Keywords
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