Neurocirculatory responses to intubation with either an endotracheal tube or a laryngeal mask airway in humans

ProSeal Laryngeal Mask Airway Attenuates Systemic and Cerebral Hemodynamic Response During Awakening of Neurosurgical Patients

“…2,6 Hemodynamic control and the avoidance of coughing or any Valsalva maneuver are key elements of optimal management during emergence, especially in these high-risk patients. 5,[9][10][11][12][13][14] Those differences are even more intense during emergence and extubation. 1,7,8 Orotracheal intubation is the standard technique for intraoperative control of the airway during neurosurgery.…”

Electroencephalographic arousal response during tracheal intubation and laryngeal mask airway insertion after induction of anaesthesia with propofol

“…The reflex pathways are polysynaptic and are from the vagal and glossopharyngeal afferents to the sympathetic nervous system, via the brainstem and spinal cord [14]. The resultant increase in sympathetic nerve activity, which was measured directly from the peroneal nerve (a postganglionic sympathetic nerve), is significantly greater with tracheal intubation than with LMA insertion [8]. Noxious stimulation also travels to the brainstem reticular formation, especially the ascending reticular activating system, and may evoke an EEG arousal response [15,16].…”

“…Previous studies have shown that insertion of a tracheal tube causes a greater haemodynamic response than insertion of an LMA [5][6][7][8]. In addition, the presence of a tracheal tube requires deeper levels of anaesthesia than that of an LMA [9].…”

“…We hypothesised that more intense noxious stimulation would cause a greater EEG arousal response. Laryngoscopy and tracheal intubation present a greater noxious stimulation than LMA insertion [5][6][7][8][9], both usually being restricted to the time of induction of anaesthesia. Therefore, we compared, after the induction of anaesthesia with propofol, EEG arousal during laryngoscopy followed by tracheal intubation with that during LMA insertion.…”

A Comparison of Airway Responses During Desflurane and Sevoflurane Administration via a Laryngeal Mask Airway for Maintenance of Anesthesia

“…The importance of a difference lies in the widespread use of the LMA for delivery of anesthesia. The LMA is widely used because it supports the airway, minimizes dead space, may be inserted without the use of muscle relaxants, provides a partial seal of the airway, can allow effective use of positive-pressure ventilation, and is less stimulating than a tracheal tube (5). However, the LMA does not prevent laryngospasm and is more difficult to use with controlled ventilation than a tracheal tube.…”