The haemodynamic and ventilatory responses with I-gel, laryngeal mask airway and tracheal intubation during laparoscopic cholecystectomy

Abstract

Background: Despite use of adequate medications and techniques, tracheal intubation induces haemodynamic stress response, which can be minimized by using supraglottic airway devices instead of tracheal tube in elective surgical cases with adequate oxygenation and ventilation. Objectives: To compare haemodynamic variables and ventilation parameters of I-gel and laryngeal mask airway with tracheal intubation during laparoscopic surgery. Methods: This is a prospective randomized comparative study among 90 cases of American Society of Anesthesiologists physical status class I and II, undergoing laparoscopic cholecystectomy, who were equally divided into three groups of 30 patients each: I-gel group, Laryngeal mask airway group and Tracheal tube group. Randomization was done with pick up of cards from sealed envelope. Basal readings of heart rate, systolic, diastolic and mean arterial pressure were recorded and these parameters were measured again before airway device placement, one, three and fi ve minutes after airway manipulation, during carboperitoneum creation and before and after extubation. Oxygen saturation, end tidal CO 2 , airway pressure and inhaled and exhaled tidal volume and minute volume were monitored before, during and after carboperitoneum creation. Leak volume was calculated by deducing exhaled tidal volume from inhaled tidal volume. Statistical analysis (Analysis of variance test) was done to see the differences among the groups. Results: Haemodynamic perturbations were maximum with tracheal intubation and moderate with laryngeal mask airway while stable haemodynamics was observed with I-gel. Intra and inter-group comparison revealed signifi cant differences after use of airway devices and after removal as well. Regarding ventilatory response, oxygenation and ventilation was well maintained with maximum airway pressure of mean ± SD: 20.11 ±3.46, 20.24 ±4.42, 19.05±4.82 cmH 2 O during carboperitoneum creation in I-gel, laryngeal mask airway and tracheal tube group respectively and oxygen saturation of 98 to 100% and end tidal CO 2 level of 31-35 mmHg. In all groups, minute volume was well maintained and leak volume of 18.88±12.40, 17.13±13.32 and 20.89±12.20 ml were recorded in I-gel, laryngeal mask airway and tracheal tube group respectively during carboperitoneum creation. There was no statistically signifi cant difference among the groups at any time regarding the monitored parameters. Conclusion: Among the three airway management devices used during general anaesthesia with positive pressure ventilation, I-gel produced least haemodynamic stress response, both supraglottic devices can be used with proper size and placement with acceptable haemodynamics and ventilation during laparoscopic surgery.

Comparative Study of Intraocular Pressure and Haemodynamic Changes Subsequent to Insertion of Laryngeal Mask Airway and Endotracheal Tube

“…However the difference in MAP was not statistically significant after airway manipulation in all the three groups. [21] The reason for this difference might be Fentanyl, Propofol and Vecuronium used in the above study more effectively attenuates the stress response than Fortwin, Thiopentone and Atracurium used in our study. The results of studies conducted by Gauri Punjabi et al (2013) and Masoomeh Tabari et al (2013) are similar to our study.…”

“…The heart rate increment was there at 3 min and 5 min after airway manipulation but the difference was not statistically significant. [21] Gauri Punjabi et al (2013) studied the cardiovascular changes subsequent to LMA insertion and found that mean pulse rate increased by 5-10/ min after LMA insertion and returned to baseline in 10 minutes. [22] In our study the mean rise in heart rate is 33/min but this difference can be due to the effect of Fentanyl, Propofol and Halothane used in the above study which can cause bradycardia.…”

Comparative evaluation of I-gel vs. endotracheal intubation for adequacy of ventilation in pediatric patients undergoing laparoscopic surgeries

“…Similarly, Maharjan in 2012 observed that hemodynamic perturbations were maximum with tracheal intubation and moderate with laryngeal mask airway whereas stable hemodynamics were observed with I-gel. [ 4 ]…”

“…This study concluded that I-gel produced the least hemodynamic stress response while both supraglottic devices had acceptable ventilation parameters during laparoscopic surgery. [ 4 ] Suhitharan also conducted a similar study in 2013 comparing I-gel to LMA Supreme. [ 5 ] However, to our knowledge, there is a paucity of studies comparing I-gel and endotracheal intubation in pediatric patients undergoing laparoscopic surgeries.…”

A Randomised Controlled Study of Comparison of Intraocular Pressure and Haemodynamic Responses to Insertion of the I-Gel, Classical Laryngeal Mask Airway and Endotracheal Tube

“…24 , they have compared haemodynamic variables of I-GEL and laryngeal mask airway with tracheal intubation during laparoscopic surgery. In their study there was increase in mean heart rate after use of airway device in all three groups, but maximum with tracheal tube and least with I-GEL.…”