Cardiovascular response to insertion of Brain's laryngeal mask

Abstract

SummaryThis study was designed to investigate the cardiovascular effects related to insertion of the Brain laryngeal mask airway and to compare these effects with those after insertion of a Guedel oral airway. Arterial pressure and heart rate in I00 patients were measured using an Ohmeda 2300 Finapres arterial pressure monitor. Arterial pressure decreased significantly ( p < 0.001) and heart rate increased significantly ( p < 0.001) after induction of anaesthesia with 2.5 mg/kg of propofol. A signijkant increase in arterial pressure ( p < 0.02) and in heart rate ( p < 0.001) followed insertion of the laryngeal mask and the Guedel airway, with no difference between the two groups at any time. The changes in arterial pressure and heart rate returned to 'at insertion' levels within 60 seconds of the stimulus.

Stress response to tracheal intubation: direct laryngoscopy compared with blind oral intubation

“…Numerous studies have demonstrated an increased stress response during direct laryngoscopy, fibreoptic intubation and insertion of the laryngeal mask [6][7][8]. Controversy exists concerning the main stimulus for tachycardia and hypertension observed during tracheal intubation.…”

Dose optimale de rémifentanil pour l’insertion d’un masque laryngé lors de la co-administration d’une dose standard unique de propofol

“…19 In the same way, the addition of remifentanil 0.25 or 0.5 lgÁkg -1 to propofol 2.5 mgÁkg -1 was well tolerated and moderated cardiovascular responsiveness to LMA insertion that were present when no opioid was co-administered with propofol. 7,19,20 There are several limitations of our study. First, only female patients were included, as this study was conducted in a gynecological unit.…”

“…17,18 In fact, insertion of the LMA constitutes a less noxious stimulus compared with laryngoscopy. Billard et al observed a significant increase in systolic blood pressure ([ 40%) during laryngoscopy and tracheal intubation after induction of anesthesia with propofol 2.5 mgÁkg -1 given alone, 19 whereas Hickey et al 20 reported minor cardiovascular response to insertion of LMA after the same dose of propofol. Yu et al 5 calculated that the optimum dose of alfentanil for inserting the classic LMA was 10 lgÁkg -1 when co-administered with popofol 2.5 mgÁkg -1 , which corresponds to one-fourth of the required dose of alfentanil for tracheal intubation when co-administered with propofol 2 mgÁkg -1 .…”

The laryngeal mask airway and intra‐ocular surgery

“…Although the LMA has been used successfully in many trials in this manner, including in the original description by Brain [I], it has been shown that an airtight seal cannot be reliably formed in all patients under these circumstances. Furthermore, it has been shown in other studies [2,3] that the pressure needed to create a significant leak around the airway in patients whose lungs are being ventilated is only 2 kPa. One of the potential consequences of this leak is the risk of aspiration of stomach contents, a scenario which has been reported and discussed in this journal fully in recent editions (4, 51.…”

“…Use of a flexible fibreoptic instrument without the help of the LMA requires an experienced operator and often takes some time; there is often a considerable increase in blood pressure and heart rate [2]. When an LMA is used relatively little expertise is required, as the shape of the mask automatically guides the fibrescope towards the vocal cord.…”