Introduction: Insertion of the laryngeal mask airway after induction of anaesthesia has been described to cause less haemodynamic changes than tracheal intubation

Aim: The purpose of the study was to compare hemodynamic response during insertion of Supraglottic device (laryngeal mask airway) and cuffed endo-tracheal tube.

Materials and Methods: This was a randomized double blinded prospective study of 60 patient of age group of 17-60 years and ASA I and II who were posted for elective surgeries requiring general anaesthesia. Patients were randomly allocated into two groups (n=30) Group “A” and “B” comprising of 40 patients each.Group A – included patients who were intubated with endotracheal tube.Group B – included patients in whom supraglottic device (LMA) was inserted. Patients were continuously monitored in the intra –operative period for the following parameters Pulse rate, percentage saturation of oxygen (SPO2), Non – invasive blood pressure (NIBP), Mean arterial pressure (MAP), Rate pressure product (RPP) and ECG.

Results: The rise in mean pulse rate in ETT group higher – following laryngoscopy and intubation, than supraglottic device group. All the groups were associated with significant increase in mean arterial but in LMA group this rise was significant. Similarily the rate pressure product was significantly raised in group A as compared to group B.

Conclusion: There was significant rise in mean pulse rate, mean arterial pressure, rate pressure product in group A during insertion of the endotracheal tube after two, five minutes than the LMA group. A significantly higher numbers of attempts were required for LMA as compared to endotracheal intubation there was a significant increase in the incidence of post-operative cough and sore-throat in the endotracheal group as compared to the LMA group B.

Keywords: Mean pulse rate, LMA, rate pressure product, hemodynamic.

1. Alan R. Aitkenhead, David J. Rowbotham, Graham Smith. Textbook of Anaesthesia. 4th ed. Churchill Livingstone; 2001, 101-106,423-514.
2. Edward Morgan G. Jr, Maged S. Mikhail, Michael J. Murray.Clinical Anaesthesiology. 4th ed. Lange Medical Books; McGrawn-HillMedical Publishing Division; 2008, 97-110.
3. Masson AHB. Pulmonary oedema during or after surgery.AnesthesiaAnalgesia.1964; 43:440.
4. Carin A. Hagberg. Benumof’s Airway Management; Principles and Practice. 2nd ed. Mosby Elsevier; 2007, Chapter 6 Editorial. (1969). Catecholamines and the heart. Lancet, 1,1200.
5. Ronald D. Miller. Miller’s Anaesthesia. 6th ed. Elsevier Churchill Livingstone; 2005, 1647.
6. Holden R Morsman CDG, Butler J, Clark GS, Hughes DS, BaconPJ. Intraocular pressure changes using the laryngeal mask airway and tracheal tube. Anaesthesia 1991; 46922-924.
7. Lamb k, James MFM, Janicki PK. The laryngeal mask airwayfor intraocular surgery: Effects on for intraocular pressure and stress responses. Br J Anaesth 1992;69:143-147.
8. Whitford AM, Hone SW, O’Hare B, Manger J, Eustace P.intraocular pressure changes following laryngeal mask airway insertion- a comparative study. Anaesthesia 1997; 52:794796.
9. Duman A, Ogun CO, Okesli S. The effect on intraocular pressure of tracheal intubation or laryngeal mask airwayinsertion during sevoflurane anaesthesia in children withoutthe use of musle relaxants. Paediatr Anaesth. 2001;11:421-424.
10. Fox EJ Skiar GS, Hill CM, Villaleuva R, King BD. Complication srelated to pressor response to endotracheal intubation. Anaesthesiology 1977; 47:564-5.
11. Shribman, A.J. smith, G. Achola KJ: Cardiovascular and catecholamine responses to laryngoscopy with and with outtracheal intubation. Br. J. Anaesth, 59:295,1987.
12. Forbes AM, Dally FG. Acute hypertension during induction ofanesthesia and endotracheal intubation in normotensiveman. Br J Anaesth 1970; 42:618-24.
13. Holden R Morsman CDG, Butler J, Clark GS, Hughes DS, BaconPJ. Intraocular pressure changes using the laryngeal mask airwayand tracheal tube. Anaesthesia 1991; 46922-924.
14. Whitford AM, Hone SW, O’Hare B, Manger J, Eustace P.intraocular pressure changes following laryngeal mask airway insertion- a comparative study. Anaesthesia 1997; 52:794796.
15. Pennat JH, Walker MB. Comparision of endotracheal tube andlaryngeal mask airway management by paramedical personnel. Anaesth Analg1992;74:531-4.
16. Burgard G, Mollhoff T, Prien DT. The effect of laryngeal maskairway cuff pressure on postoperative sorethroat incidence.J Clin Anaesth1996;8:198-201.
17. Dasey N, Mansour N. coughing and laryngospasm with laryngeal mask. Anaesthesia 1989;44:865.
18. Prys- Robert C, Greene LT, Meloche R, Foex P. Studies ofanaesthsia in relation to hypertension. Hemodynamic consequence of induction and endotracheal intubation. Br JAnaesth1971;43:531-546.
19. Lamb k, James MFM, Janicki PK. The laryngeal mask airwayfor intraocular surgery: Effects on for intraocular pressureand stress responses. Br J Anaesth1992;69:143-147.
20. Madan R, Tamilselva P, Shede D, Gupta V, Kaul HL. Intraocularpressure and hemodynamic changes after tracheal intubation andextubation: a comparative study in glaucomatous andnon-glaucomatous children. Anaesthesia 2000;55:367-390.
21. Wilson IG, Fell D, Robinson SL, Smith G. Cardiovascular responses to insertion of the laryngeal mask. Anaesthesia 1992;47: 300-302.
22. Takashi Asai, Stephen Morris. The laryngeal mask airway: itsfeatures, effects and role. Canadian Journal of Anaesthesiology1994; 41:930-960
23. Ajuzieogu., A. Amucheazi. & H. Ezike: Blood Pressure AndHeart Rate Responses To Insertion Of The Laryngeal Mask AirwayOr Tracheal Intubation. The Internet Journal of Anesthesiology.2010 Volume 27 Number 2.
24. Russell WJ, Morris RG, Frewin DB, Drew SE. Changes inplasma catecholamine concentrations during endotracheal intubation. British Journal of Anaesthesia 1981; 53:837-839.
25. Low JM, Harvey JT, Prys-Roberts C, Dagnino J. Studies ofanaesthesia in relation to hypertension. VII: Adrenergic responsesto laryngoscopy. British Journal of Anaesthesia 1986; 58:471-477.
26. Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and with outtracheal intubation. British Journal of Anaesthesia 1987; 59:S295-299.

Sudeep Mohapatra

Assistant Professor, Department of Anaesthesiology, IMS and SUM Hospital, SOA Deemed to be University, Bhubaneswar, India