Better Hemodynamic Profile of Laryngeal Mask Airway Insertion Compared to Laryngoscopy and Tracheal Intubation

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.

Preoperative Low-dose and High-dose Pregabalin and Cardiovascular Response to Endotracheal Intubation: A Prospective, Randomized, Single-blind, Controlled Study in China

“…2,3 Various therapeutic medications and methods have been employed to reduce or suppress cardiovascular responses caused by endotracheal intubation, 4 including local anesthesia, 5 intravenous lidocaine, 6 drugs affecting adrenergic receptors (eg, b-adrenoceptor antagonists, 7 a 1 -and a 2 -adrenocepter agonists 8 ), vasoactive agents (eg, glyceryl trinitrate, 9 calcium channel blockers, 10 sodium nitroprusside 11 ), and a laryngeal mask. 12 However, the optimal medicine or method to avoid stress responses in these patients has not been unequivocally established. 13 Pregabalin is a new generation of antiepileptic drug that interacts with the a 2 -d subunit of voltagedependent calcium channels in the CNS and inhibits neuronal excitability.…”

Supraglottic devices — future or everyday life?

“…Arı et al reported no significant difference in the amount of blood on LMA and I-GEL after removal from the airway [31], while Polat et al, did not report a significant difference in the responses to patients regarding pain after 24 h of use of the equipment [26]. In a study by Jarineshin et al there were no significant differences in hemodynamic variables (such as pulse or systolic and diastolic pressures) when comparing LMA and LMA-S devices with endotracheal intubation [38]. Utilization of LMA-S was reported by Van Esch and Kömür et al to result in the smallest number of airway complications [39,40].…”

Dexmedetomidine in the Management of Awake Fiberoptic Intubation

“…When AFOI is effectuated without sedation, it is commonly related to patient discomfort and severe hemodynamic responses, inducing catecholamine release by sympathetic sti-mulation, sympathetic stimulation, which may result in increased heart rate and blood pressure, arrhythmia, and cause myocardial ischemia and infarction in patients with risk factors, such as hypertension and ischemic heart disease [6,7]. The sedation may alleviate the awake intubation, but it requires conscientious administration and continuous monitoring as it can lead to airway obstruction and hypoxemia, while inadequate sedation could lead to discomfort, anxiety and excessive sympathetic discharge.…”