The Comparison of Hemodynamic Responses Following Laryngeal Mask Airway Insertion Versus Tracheal Intubation in Hypertensive Patients Scheduled for Elective Ophthalmic Surgery Under General Anesthesia

  • Mehdi Sanatkar Department of Anesthesiology and Critical Care, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • Mehrdad Goudarzi Department of Anesthesiology and Critical Care, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  • Alireza Ebrahim Soltani Department of Anesthesiology and Critical Care, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Endotracheal intubation, Hypertension, Laryngeal mask airway

Abstract

We compared hemodynamic responses following laryngeal mask airway insertion versus tracheal intubation in hypertensive patients who were scheduled for elective ophthalmic surgery under general anesthesia. We studied 48 controlled hypertensive patients that were randomly divided into two groups (n=24) for insertion of laryngeal mask airway (LMA) and endotracheal intubation (EI). The mean arterial blood pressure (MAP), heart rate, rate pressure product (RPP), and ST-segment changes were recorded preoperatively, immediately preintubation and 1, 3, and 5 minutes after LMA insertion or tracheal intubation in all patients and compared between two groups. There was a reduction in MAP after induction and immediately preintubation in all of patients of both groups (P<0.05). The MAP, heart rate and RPP increased immediately after both LMA insertion and tracheal intubation (P<0.05). The elevation of MAP and RPP were maintained for longer time in intubation group versus LMA group (P<0.05). There was no difference between the groups with respect to ST-segment variation. The incidence of airway injury was similar between two groups. The laryngeal mask airway insertion may be preferable to endotracheal intubation in hypertensive patients where attenuation of hemodynamic stress response is desired.

References

1. Fox EJ, Sklar CS, Hill CH, et al. Complication related to the pressor response to endotracheal intubation. Anesthesiology 1977; 47:524–5.
2. Kikura M, Suzuki K, Itagaki T, Takada T, Sato S. Age and comorbidity as risk factors for vocal cord paralysis associated with tracheal intubation. Br J Anaesth. 2007 Apr; 98:524-30.
3. FujiiY, Tanaka H, Toyooka H. Circulatory responses to laryngeal mask airway insertion or tracheal intubation in normotensive and hypertensive patients. Can J Anaesth. 1995; 42:32-36.
4. Stone JG, Foe¨x P, Sear JW, Johnson LL, Khambatta HJ, Triner L. Risk of myocardial ischaemia during anaesthesia in treated and untreated hypertensive patients. Br J Anaesth. 1988; 61:675–9.
5. Low JM, Harvey JT, Prys-Roberts C, Dagnino J. Studies of anaesthesia in relation to hypertension. VII. Adrenergic responses to laryngoscopy. Br J Anaesth. 1986;58:471–7.
6. Braude N, Clements EA, Hodges UM, Andrews BP. The pressor response and laryngeal mask insertion. A comparison with tracheal intubation. Anaesthesia. 1989;44:551-4.
7. Wilson IG, Fell D, Robinson SL, Smith G. Cardiovascular responses to insertion of the laryngeal mask. Anaesthesia. 1992;47:300-2.
8. Hickey S, Cameron AE, Asbury AJ. Cardiovascular response to insertion of Brain’s laryngeal mask. Anaesthesia. 1990;45:629–33.
9. Siddiqui NT, Khan FH. Haemodynamic response to tracheal intubation via intubating laryngeal mask airway versus direct laryngoscopic tracheal intubation. J Pak Med Assoc. 2007 Jan;57(1):11-4.Forbes AM, Dally FG. Acute hypertension during induction of anaesthesia and endotracheal intubation in normotensive man. Br J Anaesth 1970;42:618–24.
10. Sener EB, Ustun E, Ustun B, Sarihasan B. Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway. Clinics (Sao Paulo). 2012;67:49-54.
11. Kihara S, Brimacombe J, Yaguchi Y, Watanabe S, Taguchi N, Komatsuzaki T. Hemodynamic responses among three tracheal intubation devices in normotensive and hypertensive patients. Anesth Analg. 2003;96:890-95.
12. Kihara S, Watanabe S, Taguchi N, Suga A, Brimacombe JR. Tracheal intubation with the Macintosh laryngoscope versus intubating laryngeal mask airway in adults with normal airways. Anaesth Intensive Care. 2000;28:281-6.
13. Sener EB, Ustun E, Ustun B, Sarihasan B. Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway. Clinics (Sao Paulo). 2012;67(1):49-54.
14. Goldman L, Caldera DL. Risks of general anesthesia and elective operation in the hypertensive patient. Anesthesiology 1979; 50:285–92.
15. Kahl M, Eberhart LH, Behnke H, Sa¨nger S, Schwarz U, Vogt S, et al. Stress response to tracheal intubation in patients undergoing coronary artery surgery: direct laryngoscopy versus an intubating laryngeal mask airway. J Cardiothorac Vasc Anesth. 2004;18:275-80.
16. Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987;59:295–9.
17. Bucx MJ, Scheck PA, Van Geel RT, et al. Measurement of forces during laryngoscopy. Anaesthesia 1992;47:348–51.
18. Sanatkar M, Sadeghi M, Esmaeili N, Sadrossadat H, Shoroughi M, Ghazizadeh S, Khoshraftar E, Pour Anvari H, Alipour N. The hemodynamic effects of spinal block with low dose of bupivacaine and sufentanil in patients with low myocardial ejection fraction. Acta Med Iran. 2013;51:438-43.
19. Moezi L, Shafaroodi H, Sarkar S, Emami-Razavi SH, Sanatkar M, Mirazi N, Dehpour AR. Involvement of nitrergic and opioidergic systems in the hypothermia induced by cholestasis in rats. Pathophysiology. 2006;13:227-32.
20. Espahbodi E, Sanatkar M, Sadrossadat H, Darabi Vafsi ME, Azarshahin M, Shoroughi M. Ketamine or atropine: which one better prevents oculocardiac reflex during eye surgery? A prospective randomized clinical trial. Acta Med Iran. 2015;53:158-61.
21. Bakhshaei MH, Manuchehrian N, Khoshraftar E, Mohamadipour-Anvary H, Sanatkarfar M. Analgesic effects of intrathecal sufentanil added to lidocaine 5% in elective cesarean section. Acta Med Iran. 2010 Nov-Dec;48(6):380-4.
22. Robinson BE Relation of heart rate and systolic blood pressure to the onset of pain in angina pectoris. Circulation 1967; 35: 1073-83.
23. Cokkinos DV, Voridis EM. Constancy of pressure-rate product in pacing-induced angina pectoris. Br Heart J 1976; 38: 39-42.
24. Kissin I, Reves JG, Mardis M. Is the rate-pressure product a misleading guide? Anesthesiology. 1980;52:373-4.
25. Wallace A. Cardiovascular Disease. Chapter 25. In: Stoelting RK, Miller RD, eds. Basics of anesthesia. 5thed. Philadelphia: Churchill Livingstone. 2007; 363-92.
26. Jarineshin H, Kashani S, Vatankhah M, Abdulahzade Baghaee A, Sattari S, Fekrat F. Better Hemodynamic Profile of Laryngeal Mask Airway Insertion Compared to Laryngoscopy and Tracheal Intubation. Iran Red Crescent Med J. 2015;17: 28615.
27. Theodoraki K, Fassoulaki A. Cardiovascular responses to laryngoscopy and tracheal intubation are not accompanied by ST-segment changes. Eur J Anaesth. 2009;26:520–36.
28. Yang TM, Wei QZ, Lu WZ, Fan XL. Three-Way Laryngeal Mask Reduces Anesthesia-Related Stress Responses in Bronchoalveolar Lavage: An Experimental Canine Study. J Coll Physicians Surg Pak. 2016 Apr;26:250-4.
29. Seet E, Yousaf F, Gupta S, Subramanyam R, Wong DT,Chung F. Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events: a prospective, randomized trial. Anesthesiology. 2010;112:652-7.
30. Modir H, Moshiri E, Yazdi B, Mohammadbeigi A, Modir A. Comparing the efficacy and safety of laryngeal mask airway, streamlined liner of the pharyngeal airway and I-gel following tracheal extubation. Med Gas Res. 2018;7:241-246.
31. Sabuncu U, Kusderci HS, Oterkus M, Abdullayev R, Demir A, Uludag O, Ozdas S, Goksu M. AuraGain and i-Gel laryngeal masks in general anesthesia for laparoscopic cholecystectomy. Performance characteristics and effects on hemodynamics. Saudi Med J. 2018;39:1082-1089.
Published
2019-09-30
How to Cite
1.
Sanatkar M, Goudarzi M, Ebrahim Soltani A. The Comparison of Hemodynamic Responses Following Laryngeal Mask Airway Insertion Versus Tracheal Intubation in Hypertensive Patients Scheduled for Elective Ophthalmic Surgery Under General Anesthesia. Acta Med Iran. 57(5):289-294.
Section
Articles