Comparative study of hemodynamic responses to orotracheal intubation with intubating laryngeal mask airway and direct laryngoscope

( views:153, downloads:0 )
Author:
ZHANG Guo-hua()
XUE Fu-shan()
SUN Hai-yan()
LI Cheng-wen()
SUN Hai-tao()
LI Ping()
LIU Kun-peng()
Journal Title:
CHINESE MEDICAL JOURNAL
Issue:
Volume 119, Issue 11, 2006
DOI:
Key Word:
intubating laryngeal mask airway;general anesthesia;orotracheal intubation;hemodynamic responses

Abstract: Background Intubating laryngeal mask airway (ILMA) offers a new approach for orotracheal intubation and is expected to produce less cardiovascular stress responses. However, the available studies provide inconsistent results. The purpose of this study was to identify whether there is a clinically relevant difference in hemodynamic responses to orotracheal intubation by using ILMA and direct laryngoscope (DLS).Methods A total of 53 adult patients, ASA physical status Ⅰ-Ⅱ, scheduled for elective plastic surgery under general anesthesia requiring the orotracheal intubation, were randomly allocated to either DLS or ILMA groups.After a standard intravenous anesthesia induction, orotracheal intubation was performed. Noninvasive blood pressure and heart rate were recorded before (baseline values) and after anesthesia induction (post-induction values), at intubation and every minute for the first 5 minutes after intubation. The data were analyzed using Chisquare test, paired and unpaired Student's t test, and repeated-measures analysis of variance as appropriate.Results The mean intubation time in the ILMA group was longer than that in the DLS group (P<0.05). The blood pressure and heart rate increased significantly after intubation in the two groups compared to the postinduction values (P<0.05), but the maximum value of blood pressure during the observation did not exceed the baseline value, while the maximum value of heart rate was higher than the baseline (P<0.05). During the observation, there were no significant differences in blood pressure and heart rate among each time point and in the maximum values between the two groups.Conclusions Orotracheal intubations by using ILMA and DLS produce similar hemodynamic response. ILMA has no advantage in attenuating the hemodynamic responses to orotracheal intubation compared with DLS.

  • [1]Brain Al,Verghese C,Addy EV,Kaplia A.The intubating laryngeal mask,Ⅰ:Development of a new device for intubation of the trachea.Br J Anaesth 1997; 79:699-703.
  • [2]Brain Al,Verghese C,Addy EV,Kaplia A,Brimacombe J.The intubating laryngeal mask,ii:A preliminary clinical report of a new means of intubating the trachea.Br J Anaesth 1997; 79:704-709.
  • [3]Baskett P J,Parr M J,Nolan JP.The intubating laryngeal mask.Results of a multicentre trial with experience of 500 cases.Anaesthesia 1998; 53:1174-1179.
  • [4]Joo HS,Rose DK.The intubating laryngeal mask airway with and without fiberoptic guidance.Anesth Analg 1999;88:662-666.
  • [5]Kihara S,Yaguchi Y,Watanabe S,Brimacombe J,Taguchi N,Yamasaki Y.Haemodynamic responses to the intubating laryngeal mask and timing of removal.Eur J Anaesth 2000; 17:744-750.
  • [6]Ihara S,Watanabe S,Taguchi N,Suga A,Brimacombe JR.Tracheal intubation with the Macintosh laryngoscope vs intubating laryngeal mask airway in adults with normal airways.Anaesth Intensive Care 2000; 28:281-286.
  • [7]Choyce A,Avidan MS,Harvey A,Patel C,Timberlake C,Sarang K,et al.The cardiovascular response to insertion of the intubating laryngeal mask airway.Anaesthesia 2002; 57:330-333.
  • [8]Kahl M,Eberhart LH,Behnke H,Sanger 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; 18:275-280.
  • [9]Stoelting RK.Circulatory changes during direct laryngoscopy and tracheal intubation:influence of duration of laryngoscopy with or without prior lidocaine.Anesthesiology 1977; 47:381-383.
  • [10]Imai M,Matsumura C,Hanaoka Y,Kemmotsu O.Comparison of cardiovascular responses to airway management:fiberoptic intubation using a new adapter,laryngeal mask insertion,or conventional laryngoscopic intubation.J Clin Anesth 1995; 7:14-18.
  • [11]Takahashi SJ,Mizutani T,Miyabe M,Toyooka H.Hemodynamic responses to tracheal intubation with laryngoscope versus lightwand intubating device (Trachlight) in adults with normal airway.Anesth Analg 2002; 95:480-484.
  • [12]Helfman SM,Gold MI,DeLisser EA,Herrington CA.Which drug prevents tachycardia and hypertension associated with tracheal intubation:lidocaine,fentanyl or esmolol? Anesth Analg 1991; 72:482-486.
  • [13]Kirvela M,Scheinin M,Lindgren L.Haemodynamic and catecholamine responses to induction of anaesthesia and tracheal intubation in diabetic and non-diabetic uraemic patients.Br J Anaesth 1995; 74:60-65.
  • [14]Houghton IT,Low JM,Lau JT,OH TE.An ethnic comparison of the sympathetic response to tracheal intubation.Anaesthesia 1993; 48:965-968.
  • [15]Shribman A J,Smith G,Achola KJ.Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation.Br J Anaesth 1987; 59:295-299.
  • [16]Bucx M J,Scheck PA,Van Geel RT,Den Ouden AH,Niesing R.Measurement of forces during laryngoscopy.Anaesthesia 1992; 47:348-351.
  • [17]Shribman A J,Smith G,Achola KJ.Cardiovascular and catecholamines responses to laryngoscopy with and without tracheal intubation.Br J Anaesth 1987; 59:295-299.
  • [18]Shinji T,Taro M,Masayuki M,Hidenori T.Hemodynamic responses to tracheal intubation with laryngoscope versus lightwand intubating device (Trachlight) in adults with normal airway.Anesth Analg 2002; 95:480-484.
  • [19]Singh S,Smith JE.Cardiovascular changes after the three stages of nasotracheal intubation.Br J Anaesth 2003; 91:667-671.
  • [20]Keller C,Brimacombe J.Pharyngeal mucosal pressures,airway sealing pressures,and fiberoptic position with the intubating versus the standard laryngeal mask airway.Anesthesiology 1999; 90:1001-1006.
  • [21]Keller C,Brimacombe J,Keller K.Pressures exerted against the cervical vertebrae by the standard and intubating laryngeal mask airway:a randomized,controlled,cross-over study in fresh cadavers.Anesth Analg 1999; 89:1296-1300.
  • [22]Hirabayashi Y,Hiruta M,Kawakami T,Inoue S,Fukuda H,Saitoh K,et al.Effects of lightwand (Trachlight)compared with direct laryngoscopy on circulatory responses to tracheal intubation.Br J Anaesth 1998;81:253-255.
  • [23]Hamaya Y,Dohi S.Differences in cardiovascular response to airway stimulation at different sites and blockade of the responses by lidocaine.Anesthesiology 2000; 93:95-103.
  • [24]Shimoda O,Yoshitake A,Abe E,Koga T.Reflex responses to insertion of the intubating laryngeal mask airway,intubation and removal of the ILMA.Anaesth Intensive Care 2002; 30:766-770.
  • [25]Adachi YU,Takamatsu I,Watanabe K,Uchihashi Y,Higuchi H,Satoh T.Evaluation of the cardiovascular responses to fiberoptic orotracheal intubation with television monitoring:comparison with conventional direct laryngoscopy.J Clin Anesth 2000; 12:503-508.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615 Email:yiyao@wanfangdata.com.cn