Circulatory responses to laryngeal mask airway insertion or tracheal intubation in normotensive and hypertensive patients

Abstract

The effects of laryngeal mask airway (LMA) insertion and tracheal intubation on circulatory responses were studied in normotensive (n = 24) and hypertensive (n = 22) Les r$percussions de l'insertion du masque laryngd (ML) et de l~ntubation endotrachdale sur la circulation sont dtudides chez des normotendus (n = 24) et des hypertendus (n = 22). Au hasard et h double aveugle, le ML ou le tube endotrachdal est installd apr~s une induction au thiopentone avec relaxation musculaire ~ la succinylcholine. Comparativement aux niveaux initiaux, aussi bien chez les normo-que chez les hypertendus, la frdquence cardiaque (FC), la pression artirielle rnoyenne (PAM) et le produit frdquence-pression augmentent, clue ce soit aprbs l'intubation ou l~nsertion du ML (P < 0,05). Les changements hdmodynamiques sont plus prononcds apr~s l~ntuba-tion qu'aprbs l~nsertion du ML (P < 0,05). Aprbs l~ntubation de la trachde ou l~nsertion du MI_, chez l'hypertendu, la FC augmente de fafon plus marqude que chez le normotendu (P < 0,05). Les concentrations plasmatiques d'adrdnaline et de noradrdnaline augmentent apr~s l~ntubation ou l'insertion du ML comparativement aux valeurs initiales (P < 0,05) tant chez les normo-que chez les hypertendus. L'augmentation de la concentration de noradrdnaline apr~s l~ntubation est plus importante qu'aprds l~nsertion du ML (P < O,05,t Chez aucun des patients, on n'a ddceld dischdmie myocardique ~ I'ECG. Nous concluons que l~nsertion du ML est associde ?t des rdpercussions circulatoires moindres que l'intubation endotrach$ale aussi bien chez les norrno-que chez les hypertendus.Key words EQUIPMENT: laryngeal mask airway; [NTUBATION, TRACHEAL: complications; COMPLICATIONS' . tachycardia, hypertension. Accepted for publication 8th September, 1994. Laryngoscopy and tracheal intubation after induction of anaesthesia are frequently associated with transient hypertension, tachycardia and arrhythmias. Although these haemodynamic responses are probably of little consequence in healthy individuals, they may be more severe and more hazardous in hypertensive patients. ~ Laryngeal mask airway (LMA) insertion, originally described by Brain,2 has recently become widely used in airway management. 3 Insertion of the LMA after induction of anaesthesia causes less haemodynamic change than tracheal intubation. 4,5 However, the effects of LMA insertion after CAN J ANAESTH 1995 / 42:1 / pp 32-6

“Comparison of Cuff Pressure Changes Between Air with Oxygen or Nitrous Oxide with Oxygen During General Anaesthesia Using Proseal LMA for Laproscopic Surgery”

“…These findings are similar to those of previous studies . [6,7,8,9,11 ]. In Our study there was no difference in both the groups A and group N in terms of pulse rate, mean arterial blood pressure , SpO2, EtCO2 and peak airway pressures.…”

“…Studies by Cook, Shroff and co-workers(medianeffective time 15 s) corroborated with our study findings. [8,9] Sharma andcoworkers reported a mean insertion time of 13.51 s and 12 s, respectively for PLMA [6,10] .…”

Comparison of haemodynamic responses in normotensive and hypertensive patients among three intubation devices: macintosh laryngoscope, intubating laryngeal mask airway and lightwand

“…In addition, hemodynamic responses after laryngoscope-guided tracheal intubation are more pronounced in hypertensive patients. 4,5 S. Kihara et al found that both the ILMA and the LW provoke a milder stress response to tracheal intubation compared with the LS in hypertensive patients but not in normotensive patients. 6 Kohki Nishikawa et al concluded that the lightwand technique caused lesser hemodynamic changes in normotensive patients than the laryngoscope.…”

Reflex circulatory responses after three stages of nasotracheal intubation and two stages of orotracheal intubation: A comparative study

“…Consequently, there is evidence that the magnitude of the pressor response varies with the intubation techniques. 16,17,18,19 In this study, we have divided nasotracheal intubation into three distinct stages namely -nasopharyngeal intubation, direct laryngoscopy, tracheal intubation and orotracheal intubation into two stages -direct laryngoscopy and tracheal intubation with the objective to identify the haemodynamic changes that occur during each stage of intubation through oral and nasal routes. We have used conventional laryngoscope and endotracheal tube wherever applicable.…”