Title: Hemodynamic Response in Hypertensive Patients with Endotracheal intubation and Laryngeal mask airway- A Comparative study
Authors: Dr Irukulla Avanthi, Dr Uppalapati Swathi, Dr S.Manohar
DOI: https://dx.doi.org/10.18535/jmscr/v6i10.39
Abstract
The haemodynamic response associated with laryngoscopy and tracheal intubation may be harmful to certain patients. The laryngeal mask airway (LMA) avoids the need for laryngoscopy and allows positive pressure ventilation of the lungs in appropriate patients. This study compared the haemodynamic response of tracheal intubation with that of mask insert ion in hypertensive patients. Sixty hypertensive patients between 40-60 years of either sex of ASA grade II were randomly allotted to one of the two groups of 30 each (group ET vs group LMA). LMA insert ion or tracheal intubation was performed after induct ion of anaesthesia with thiopentone, and muscle relaxation with succinylcholine. The heart rate, systolic BP, diastolic BP, mean arterial pressure (MAP) and rate pressure product (RPP) were measured after induct ion, immediately after intubation or insert ion and at minute 1, 3 and 5. There was a very highly significant difference (P < 0.001) in mean peak increase in heart rate (59.2% in group ET vs 36% in group LMA). The increase in arterial pressures were very similar. The systolic BP increased by 29.5% in group ET compared with 27% in group LMA and diastolic BP increased by 15.2% and 16.2% in group ET and group LMA respectively. The MAP and RPP reached maximum values immediately after airway instrumentation. However, the values after LMA insert ion were significantly lower compared to tracheal intubation after one minute. Use of LMA may therefore offer some limited advantages over tracheal intubation in the anaesthetic management o f patients where the avoidance of the pressure response is of particular concern.
Keywords: Include at least 5 to 6 keywords or phrases
References
- Ronald D. Miller. Miller’s Anaesthesia. 6t h Elsevier Churchill Livingstone ; 2005, 1647.
- Jerry A. Dorsch. Understanding anaesthesia equipment. 4 t h William and Wilkins; 1999, 464-487.
- Yoshitaka Fujii, Hiroyoshi Tanaka, Hidenori Toyooka. Circulatory responses to laryngeal mask airway insertion or tracheal intubation in normotensive and hypertensive patients. Canadian Journal of Anaesthesiology 1995; 42: 32-36.
- Wilson IG, Fell D, Robinson SL, Smith G. Cardiovascular responses to insertion of the laryngeal mask. Anaesthesia 1992; 47: 300 - 302.
- Hickey S, Cameron AE, Asbury AJ. Cardiovascular response to insertion of brain’s laryngeal mask. Anaesthesia 1990; 45: 629-633.
- Braude N, Clements EAF, Hodges UM, Andrews BP. The pressor response and laryngeal mask insertion. A comparison with tracheal intubation. Anaesthesia 1989; 44: 551-554.
- Griffin RM, Dodd P, Buckoke PC, Tosh GC, Day SJ. Cardiovascular responses to insertion of the brain laryngeal mask. British Journal of Anaesthesia 1989; 63:624-625.
- Shribman AJ, Smith G, Achola Cardio vascular and catecholamine to laryngoscopy with and without tracheal responses intubation. British Journal of Anaesthesia 1987; 59: 295-299.
- Marjot R. Pressure exerted by the laryngeal mask airway cuff upon the pharyngeal mucosa. British Journal of Anaesthesia 1993; 70:25-29.
- Anita N. Shetty, Shinde VS, Chaudhari LJ. A comparative study of various airway devices as regards ease of insertion and haemodynamic responses. Indian Journal of Anaesthesia 2004; 48(2): 134-137.