A comparative study of hemodynamic response with Laryngoscopic endotracheal intubation and laryngeal Mask airway insertion in hypertensive patients

Abstract

Background:The hemodynamic response which has been associated with laryngoscopy and tracheal intubation may be harmful to certain patients. The laryngeal mask airway decreases the need for laryngoscopy and provides positive pressure ventilation in appropriate patients.Aim:This is a comparative study of hemodynamic response with laryngoscopy and endotracheal intubation and LMA insertion in hypertensive patients.Materials and Methods:60 Hypertensive patients aged between 40 to 60 years of either sex of ASA grade II were randomly allotted into two groups of 30 each, group ET and group LMA. LMA insertion or tracheal intubation was performed after inducing with propofol and muscle relaxation with succinyl choline. Anesthesia was maintained with isoflurane, oxygen and nitrous oxide, the heart rate, SBP, DBP, mean arterial pressure were measured after induction and immediately after insertion / intubation and then after 1, 3, 5 minutes.Results:There was a significant difference (p < 0.000) in mean increase in heart rate (38.23% in group ET versus 28.26% in group LMA). The increase in arterial pressure was also significant. The SBP increased 40.16% in group ET compared with 37.60% in group LMA (p< 0.000). The DBP was also increased by 22.73% and 14.23% in group ET and group LMA respectively. The MAP values were maximum after airway instrumentation. However, we found that the values after LMA insertion were significantly low compared to tracheal intubation for the first 3 minutes.Conclusion:The data suggest a similar, but attenuated response associated with mask insertion in comparison to laryngoscopy and intubation. Hence use of LMA may offer some advantage over tracheal intubation in anesthetic management of patients where avoidance of pressure response is of particular concern.