Title: Comparison of Hemodynamic Responses and Postoperative Airway Complications between ET Tube and LMA in Pediatric Short Surgical Procedures
Authors: G.Kiran Kumar, Abhimanyu Singh*, Uppalapati Bhavana
DOI: http://dx.doi.org/10.18535/jmscr/v3i8.04
DIDS : 08.2015-64841982
Back ground: Securing a safe airway is always the prime priority of an anaesthesiologist. Among the various methods to achieve this, laryngoscopy and endotracheal intubation enjoys a major role. Although it is very efficient in maintaining a patent airway, it has its own array of complications Aim: The present study was designed to assess the suitability of LMA as a substitute to laryngoscopy and endotracheal intubation in pediatric patients undergoing short surgical procedures under general anesthesia posted in 11 months period. Materials and methods: The study group consisted of 100 patients aged between 5 to 15 years, scheduled for various surgeries to which general anaesthesia was administered. Subjects were randomly allocated to one of the following two groups of 50 each as group-L with LMA insertion and controlled ventilation and group-T with Laryngoscopy and endotracheal intubation and controlled ventilation. The haemodynamic changes as noted in changes of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) observed during endotracheal intubation and LMA insertion were compared and studied and postoperative sore throat incidence was observed after 8, 24, 48 hours. Results: There was a significant rise in HR in both the groups but the rise in endotracheal group was more significant and sustained, i.e., a rise of 16.2% from baseline after endotracheal intubation,14.2% after 1 min, 9.4% after 2 min and 4.8%after 3 min. while that of LMA group was 4.4%, 2.8%, 1.2%and 0.4%. The SBP at the same time intervals were 11.9%, 11.9%, 7.9%, 2.1% above baseline in group T and 3.6%, 5.2%, 5.3%, 5.4% below baseline for group L. The DBP were 11.2%, 8.9%, 5.6%, 2.1% above baseline in group T and in 3.2%, 5.1%, 5.6%, 6.2% below baseline for group L. The incidence of post operative sore throat was 8% in group L and in 20% in group T. Conclusions: Laryngeal mask airway is a valuable and better alternative to endotracheal intubation in securing the airway, especially in pediatric patients in whom pressor response to endotracheal intubation is detrimental. Keywords: Laryngoscopy, Endotracheal intubation, Haemodynamic changes, Sore throat. 1. Brain AIJ. The laryngeal mask – new concept in airway management. Br. J Anaesth 1983; 55; 801-5. 2. Shetty AN, Shinde VS, Chaudhari LS. A comparative study of various airway devices as regards ease of insertion and haemodynamic responses. Indian J Anaesth 2004 ; 48(2) : 134 -137. 3. I.G. Wilson, D. Fell, S.L. Robinson and G. Smith : “Cardiovascular responses to insertion of the laryngeal mask”. Anaesthesia 1992 ; volume 47, page 300- 302. 4. S. Hickey, A.E. Cameron and A.J. Asbury : “Cardiovascular response to insertion of Brain’s Laryngeal Mask.” Anaesthesia 1990; Volume 45, Pages 629-633. 5. N. Braude, E.A.F. Clements, U.M. Hodges and B.P. Andrews : “The pressor response and laryngeal mask insertion.” Anaesthesia 1989; volume 44, pages 551-554. 6. Lamb K, james FM, Janiki PK. The laryngeal mask airway for intraocular surgery effects on intraocular pressure and stress responses. Br J Anaesth 1992; 69:143-147. 7. ALEXANDER CA, LEACH AB, THOMPSON AR, LISTER JB. Use your Brain. Anaesthesia 1988; 43: 893. 8. Lalwani J, Dubey KP, Sahu BS, Shah PJ. ProSeal laryngeal mask airway: An alternative to endotracheal intubation in paediatric patients for short duration surgical procedures. Indian J Anaesth 2010;54:541-5 9. Jamil SN et al: Comparison of LMA and endotracheal intubation in children. Indian J Anaesth 2009; 53 (2):174-178 10. Klockgether-Radke A, Gerhardt D, Mulendyck H, Braun U. The effect of the laryngeal mask airway on the postop incidence of sore throat in children. Anaesthesist 1996;45(11):1085 8.Abstract
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