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A COMPARATIVE STUDY TO EVALUATE HEMODYNAMIC CHANGES BETWEEN ENDOTRACHEAL INTUBATION AND PROSEAL LARYNGEAL MASK AIRWAY INSERTION IN PATIENTS UNDERGOING GENERAL ANAESTHESIA
Abstract
Background: Hemodynamic stability is an important aspect to the anesthesiologist for patients. Laryngoscopy and endotracheal intubation can cause striking changes in Hemodynamics as result of intense stimulation of sympathetic nervous system. ProSeal LMA (PLMA)minimizes this response without compromising the airway. The aim of this study was to compare PLMA and Endotracheal tube with respect to intra-operative hemodynamic responses in patients undergoing general anaesthesia. Material and Methods: This prospective observational study was conducted on 30 patients of either sex, age group of 18-60 years, ASA (I or II), Mallam Pati (I or II) posted for elective surgery under general anaesthesia. They were randomly divided into two group 15 each. For group A, airway was secured with laryngoscopy and intubation with appropriate size endotracheal tube and for group B, appropriate size PLMA was inserted to secure airway. The hemodynamic responses like Heart rate and Blood pressure were recorded at base line, at insertion, after 1st min, 3rd min, 5th min and after extubation. Mean increase was statistically more after endotracheal intubation than PLMA insertion. The elevation in theseResults: hemodynamic parameters signicantly persisted for a longer period of time in the ETT group, where it returned to the baseline value by 5 minutes as compared to the PLMA group where it returned by 3 minutes. The hemodynamic response produced when PLMA was used forConclusion: securing airway was less than the laryngoscopy and endotracheal intubation. Thus, PLMA proved to be a suitable alternative to endotracheal tube for airway management with stable hemodynamic.
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In a prospective randomized study pressor responses and intraocular pressure changes following insertion of laryngeal mask airway and endotracheal tube were compared in two groups of twenty five patients each undergoing elective non-ophthalmic surgical procedures. In group I, laryngeal mask airway was used whereas in group II endotracheal tube was inserted. Baseline and pre-insertion values of heart rate, systolic blood pressure, diastolic blood pressure and intraocular pressure were recorded and repeated at one, two and three minutes after insertion of laryngeal mask airway or endotracheal tube. Our results showed a significant increase in systolic and diastolic blood pressure as well as in intraocular pressure in endotracheal tube group as compared to laryngeal mask airway group (p<0.01). Heart rate showed an increase in both the groups but the difference was statistically insignificant. It was concluded from the study that the use of laryngeal mask airway might offer some advantages in patients where minimal changes in hemodynamics and intraocular pressure are desirable.
Aims to compare the efficacy of Proseal laryngeal mask airway(PLMA) and endotracheal tube (ETT) in patients undergoing laparoscopic surgeries under general anaesthesia. This prospective randomised study was conducted on 60 adult patients, 30 each in two groups, of ASA I-II who were posted for laparoscopic procedures under general anaesthesia. After preoxygenation, anaesthesia was induced with propofol, fentanyl and vecuronium. PLMA or ETT was inserted and cuff inflated. Nasogastric tube (NGT) was passed in all patients. Anaesthesia was maintained with N(2) O, O(2), halothane and vecuronium. Ventilation was set at 8 ml/kg and respiratory rate of 12/min. The attempts and time taken for insertion of devices, haemodynamic changes, oxygenation, ventilation and intraoperative and postoperative laryngopharyngeal morbidity (LPM) were noted. There was no failed insertion of devices. Time taken for successful passage of NGT was 9.77 s (6-16 s) and 11.5 s (8-17 s) for groups P and E, respectively. There were no statistically significant differences in oxygen saturation (SpO(2)) or end-tidal carbon dioxide (EtCO(2)) between the two groups before or during peritoneal insufflation. Median (range) airway pressure at which oropharyngeal leak occurred during the leak test with PLMA was 35 (24-40) cm of H(2)O. There was no case of inadequate ventilation, regurgitation, or aspiration recorded. No significant difference in laryngopharyngeal morbidity was noted. A properly positionedPLMA proved to be a suitable and safe alternative to ETT for airway management in elective fasted, adult patients undergoing laparoscopic surgeries. It provided equally effective pulmonary ventilation despite high airway pressures without gastric distention, regurgitation, and aspiration.
The electrocardiographic and haemodynamic responses to the induction of anaesthesia, followed by laryngoscopy and endotracheal
intubation have been studied in a group of 16 untreated hypertensive patients, and a group of 20 patients receiving antihypertensive
therapy up to and including the day of operation. The influence of five different induction agents, thiopentone, methohexitone,
propanidid, diazepam, and neuroleptanalgesia induced by a combination of phenoperidine and droperidol were compared. Neuroleptanalgesia
caused less arterial hypotension than any of the other agents, but afforded only marginally more protection than other agents
against hypertension, tachycardia and dysrhythmia associated with laryngoscopy and tracheal intubation. Both propanidid and
diazepam caused dramatic but transient hypotension in a small number of patients and were not investigated further. Unlike
its effects in normotensive subjects, methohexitone caused greater hypotension than thiopentone in hypertensive patients.
The rationale is presented for the prophylactic blockade of beta-adrenergic receptors to prevent hypertensive crises during
laryngoscopy and intubation in both treated and untreated hypertensive patients.
The laryngeal mask airway (LMA) is a supraglottic airway management device. The LMA is preferred for airway management in paediatric patients for short duration surgical procedures. The recently introduced ProSeal (PLMA), a modification of Classic LMA, has a gastric drainage tube placed lateral to main airway tube which allows the regurgitated gastric contents to bypass the glottis and prevents the pulmonary aspiration. This study was done to compare the efficacy of ProSeal LMA with an endotracheal tube in paediatric patients with respect to number of attempts for placement of devices, haemodynamic responses and perioperative respiratory complications. Sixty children, ASA I and II, weighing 10-20 kg between 2 and 8 years of age group of either sex undergoing elective ophthalmological and lower abdominal surgeries of 30-60 min duration, randomly divided into two groups of 30 patients each were studied. The number of attempts for endotracheal intubation was less than the placement of PLMA. Haemodynamic responses were significantly higher (P<0.05) after endotracheal intubation as compared to the placement of PLMA. There were no significant differences in mean SpO(2) (%) and EtCO(2) levels recorded at different time intervals between the two groups. The incidence of post-operative respiratory complications cough and bronchospasm was higher after extubation than after removal of PLMA. The incidence of soft tissue trauma was noted to be higher for PLMA after its removal. There were no incidences of aspiration and hoarseness/sore throat in either group. It is concluded that ProSeal LMA can be safely considered as a suitable and effective alternative to endotracheal intubation in paediatric patients for short duration surgical procedures.
Background: Endotracheal intubation has been the gold standard for airway management in laparoscopic surgery. The ProSeal LMA (PLMA) has been safely used in adult laparoscopies. The presence of the drain tube and the better seal provided by the ProSeal effectively prevents regurgitation and safeguards against pulmonary aspiration. This study was undertaken to evaluate the use of the ProSeal in paediatric laparoscopy. Patients & Methods: Thirty children, weighing between 10-30 kg undergoing elective laparoscopic surgery of short duration (< 60 minutes) were studied. All patients were maintained on controlled ventilation. Gastric tube was inserted in all patients. Insertion characteristics of the PLMA, haemodynamic responses to LMA insertion, adequacy of airway seal, effectiveness of oxygenation and ventilation were studied. pH of secretions on the PLMA cuff following removal and any incidence of adverse effects were noted. Results: The ProSeal was easy to insert in all patients. We needed to use the Chandy's manouvre to optimize ventilation in 4 patients. In 2 patients, the PLMA had to be replaced by endotracheal tube due to inadequate ventilation. The airway seal afforded by the PLMA was adequate even after insufflation and Trendelenberg positioning. Absence of regurgitation was confirmed by pH testing of secretions on the cuff of the device; mean pH was alkaline. Conclusion: The PLMA is a safe and effective option for maintaining the airway in children undergoing short duration laparoscopy.
The stress responses from tracheal intubation are potentially dangerous in patients with higher cardiovascular risk, such as obese patients. The primary outcome objective of this study was to test whether, in comparison with the endotracheal tube (ETT), the Proseal™ Laryngeal Mask Airway (PLMA™) (Laryngeal Mask Airway Company, Jersey, United Kingdom) reduces blood pressure and norepinephrine responses and the amounts of muscle relaxants needed in obese patients.
We assessed hemodynamic and hormonal stress responses, ventilation, and postoperative recovery in 75 morbidly obese patients randomized to receive standardized anesthesia with either an ETT or the PLMA™ for laparoscopic gastric banding.
In repeated-measures ANOVA, mean arterial blood pressure and plasma norepinephrine were significantly higher in the ETT group than in the PLMA™ group. In individual pairwise comparisons, blood pressure rose higher in ETT than PLMA™ patients after insertion and removal of airway devices, and after recovery. In ETT compared with PLMA™ patients, plasma norepinephrine was higher after induction of carboperitoneum (mean ± SD, 534 ± 198 and 368 ± 147 and pg/ml, P = 0.001), after airway device removal (578 ± 285 and 329 ± 128 pg/ml, P < 0.0001), and after recovery in postanesthesia care unit (380 ± 167 and 262 ± 95 and pg/ml, P = 0.003). Compared with use of the ETT, the PLMA™ reduced cisatracurium requirement, oxygen desaturation, and time to discharge from both the postanesthesia care unit and the hospital.
PLMA™ reduces stress responses and postoperative complaints after laparoscopic gastric banding.
The pressor response associated with laryngoscopy and tracheal intubation may be harmful to certain patients. The laryngeal mask airway avoids the need for laryngoscopy and allows positive pressure ventilation of the lungs in appropriate patients. This study compared the pressor response of tracheal intubation with that of mask insertion in two groups of 24 and 23 healthy patients respectively. All patients were anaesthetised with thiopentone, nitrous oxide, enflurane and paralysed with atracurium. We have shown a similar, but attenuated pattern of response associated with mask insertion in comparison with laryngoscopy and intubation; significant differences between the groups were evident in arterial diastolic blood pressure immediately after insertion and again 2 minutes later. Use of the laryngeal mask may therefore offer some limited advantages over tracheal intubation in the anaesthetic management of patients where the avoidance of the pressor response is of particular concern.
To compare LMA-ProSeal (LMA-PS) with endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during laparoscopic cholecystectomy.
We randomized 109 ASA I-III adults to LMA-PS or ETT after stratifying them as non-obese or obese (body mass index > 30 kg x m-2). After preoxygenation, anesthesia was induced with propofol, fentanyl and rocuronium. An LMA-PS (women #4, men #5) or ETT (women 7 mm, men 8 mm) was inserted and the cuff inflated. A #14 gastric tube was passed into the stomach in every patient and connected to continuous suction. Anesthesia was maintained with nitrous oxide, oxygen and isoflurane. Ventilation was set at 10 mL x kg-1 and 10 breaths x min-1. The surgeon, blinded to the airway device, scored stomach size on an ordinal scale of 0-10 at insertion of the laparoscope and upon decompression of the pneumoperitoneum.
There were no statistically significant differences in SpO2 or P(ET)CO2 between the two groups before or during peritoneal insufflation in either non-obese or obese patients. Median (range) airway pressure at which oropharyngeal leak occurred during a leak test with LMA-PS was 34 (18-45) cm water. Change in gastric distension during surgery was similar in both groups. Four of 16 obese LMA-PS patients crossed over to ETT because of respiratory obstruction or airway leak.
A correctly seated LMA-PS or ETT provided equally effective pulmonary ventilation without clinically significant gastric distension in all non-obese patients. Further studies are required to determine the acceptability of the LMA-PS for laparoscopic cholecystectomy in obese patients.
Supraglottic airway devices
- J A Dorsch
- S E Dorsch
Dorsch JA, Dorsch SE, 2008. Supraglottic airway devices. In: Understanding
Anesthesia Equipment. 5th ed. Philadelphia: Wolters Kluwer, Lipincott Williams and
Wilkins. Pages-475.