Better Hemodynamic Profile of Laryngeal Mask Airway Insertion Compared to Laryngoscopy and Tracheal Intubation
Open Access
- 12 August 2015
- journal article
- Published by DoNotEdit in Iranian Red Crescent Medical Journal
- Vol. 17 (8), e28615
- https://doi.org/10.5812/ircmj.28615
Abstract
Background: Laryngoscopy and tracheal intubation can cause serious cardiovascular responses in patients such as hypertension, tachycardia, and arrhythmias. Alternative airway maintenance techniques may attenuate these hemodynamic stress responses. Objectives: This study aimed to compare the immediate hemodynamic effects of the insertion of laryngeal mask airway supreme (LMA-S) and classic (LMA-C) with laryngoscopy and Endotracheal Intubation (ETT). Patients and Methods: This study was a prospective, double-blind, and randomized clinical trial conducted on 150 patients aged 18 to 50 years with ASA I (American Society of Anesthesiologists), in the general operating room of Shahid Mohammadi hospital, Hormozgan university of medical sciences, Bandar Abbas, Iran. In the ETT group, endotracheal intubation was performed using the Macintosh laryngoscope; while for the LMA-C and LMA-S groups, LMA Classic and LMA Supreme were inserted, respectively. The induction and maintenance of anesthesia were similar in all patients. The hemodynamic parameters such as heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured before (baseline) and after induction of anesthesia at 4 different time points. The statistical analysis was done and P value less than 0.05 was considered significant. Results: Participants in all groups were similar in terms of gender, age, weight, height, and Mallampati class. The mean ± SD of SBPs (105.62 ± 12.12, 112.90 ± 12.2, and 112.48 ± 15.14 mm Hg, respectively for ETT, LMA-C, and LMA-S) and DBPs (64.64 ± 10.23, 73.78 ± 9.70, and 71.20 ± 12.27 mm Hg, respectively for ETT, LMA-C, and LMA-S) were significantly lower in the ETT group compared to LMA groups 5 minutes after device insertion (P < 0.01 for SBPs and P < 0.001 for DBPs); however these values were lower than the baseline values in all groups. There were no differences in the mean SBP and DBPs between the three groups at the other time points. The mean ± SD heart rates in the ETT group, compared to the LMA-C and LMA-S groups, were considerably higher in the first minute (100.06 ± 18.27, 82.50 ± 10.52, and 82.00 ± 13.60 bpm, respectively for ETT, LMA-C, and LMA-S), third minute (91.04 ± 17.12, 78.84 ± 11.23, and 78.90 ± 13.41 bpm, respectively for ETT, LMA-C, and LMA-S) and fifth minute (85.82 ± 16.01, 75.78 ± 11.73, and 75.04 ± 13.90 bpm, respectively for ETT, LMA-C, and LMA-S) after intubation (P < 0.001). There were no significant differences between the LMA-C and LMA-S groups in terms of hemodynamic parameters. Conclusions: Maintaining the airway using laryngeal mask airway is associated with less cardiovascular responses compared to direct laryngoscopy and tracheal intubation. Keywords: Laryngeal Masks; Airway Management; Intubation-Intratracheal; Hemodynamics; Blood Pressure; Heart RateKeywords
This publication has 25 references indexed in Scilit:
- The LMA SupremeTM– a pilot studyAnaesthesia, 2008
- Cardiovascular changes with the laryngeal mask airway in cardiac anaesthesiaBritish Journal of Anaesthesia, 2004
- Hemodynamic Responses Among Three Tracheal Intubation Devices in Normotensive and Hypertensive PatientsAnesthesia & Analgesia, 2003
- The Intubating Laryngeal Mask Airway With and Without Fiberoptic GuidanceAnesthesia & Analgesia, 1999
- The haemodynamic response to the insertion of the laryngeal mask airway: a comparison with laryngoscopy and tracheal intubationActa Anaesthesiologica Scandinavica, 1994
- Measurement of forces during laryngoscopyAnaesthesia, 1992
- A bolus dose of esmolol attenuates tachycardia and hypertension after tracheal intubationCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1990
- RISK OF MYOCARDIAL ISCHAEMIA DURING ANAESTHESIA IN TREATED AND UNTREATED HYPERTENSIVE PATIENTSBritish Journal of Anaesthesia, 1988
- CARDIOVASCULAR AND CATECHOLAMINE RESPONSES TO LARYNGOSCOPY WITH AND WITHOUT TRACHEAL INTUBATIONBritish Journal of Anaesthesia, 1987
- Complications Related to the Pressor Response to Endotracheal IntubationAnesthesiology, 1977