HAEMODYNAMIC RESPONSES TO TRACHEAL EXTUBATION OR LARYNGEAL MASK AIRWAY REMOVAL IN PATIENTS UNDERGOING SHORT SURGICAL PROCEDURES: A COMPARATIVE AND CLINICAL STUDY

NIKITA BHAGWAT PHAPHAGIRE; PRAVIN UBALE; ANESA B SYED

doi:10.22159/ajpcr.2023.v16i2.47231

Authors

NIKITA BHAGWAT PHAPHAGIRE Department of Anaesthesiology, MGM Medical College, Aurangabad, Maharashtra, India.
PRAVIN UBALE Department of Anaesthesiology TNMC and B.Y.L. Nair Hospital, Mumbai, Maharashtra India.
ANESA B SYED Department of Anaesthesiology, Government Medical College and Hospital, Aurangabad, Maharashtra, India.

DOI:

https://doi.org/10.22159/ajpcr.2023.v16i2.47231

Keywords:

Endotracheal Intubation, Laryngeal Mask Airway, Extubation, Haemodynamic Stability

Abstract

Aims and Objectives: The aim of the study was to evaluate and compare the hemodynamic responses after endotracheal tube (ET) extubation and laryngeal mask airway (LMA) removal in American Society of Anaesthesiologists (ASA) I and ASA II patients undergoing short surgical procedures.

Methods: This was a randomized, comparative, observational, and clinical study conducted in a tertiary care medical college. The duration of study was 1 year. Hundred patients of ASA Grade I and II with age between 18 and 60 years, including both males and females posted for short surgeries under general anesthesia were selected for the study. Patients were divided into two groups (Depending on whether endotracheal intubation was done or LMA was used) of 50 patients each. Hemodynamic parameters (systolic blood pressure [SBP], diastolic blood pressure [DBP], mean arterial pressure [MAP], and heart rate [HR]) were recorded and compared before induction, during surgery and postoperatively at 1, 2, 5, and 10 min between both the groups.

Results: There was no significant difference between these two groups regarding the demographic aspect of the patients such as age and gender. Furthermore, the parameters such as ASA grade and duration of surgery were comparable. The baseline hemodynamic parameters between the two groups were also similar and no significant difference was observed. The changes in hemodynamics (mean HR, SBP, DBP, and MAP) were more in Group E as compared to Group L and the difference was found to be statistically significant (p<0.05). Similarly respiratory events were more profound in Group E as compared to Group L and the difference was found to be statistically significant (p<0.05).

Conclusion: LMA is a better choice for short surgical procedures as it provides more hemodynamic stability during removal as compared to ET extubation. LMA is also associated with less complications as compared to ET.

Downloads

Download data is not yet available.

References

Lee JH. Anesthesia for ambulatory surgery. Korean J Anesthesiol 2017;70:398-406. doi: 10.4097/kjae.2017.70.4.398, PMID 28794834

Zaman B, Noorizad S, Safari S, Larijani SM, Siamdoust SA. Efficacy of laryngeal mask airway compared to endotracheal tube: A randomized clinical trial. Anesth Pain Med 2022;12:e120478. doi: 10.5812/ aapm.120478, PMID 35433385

Andreu MF, Bezzi MG, Dotta ME. Incidence of immediate postextubation complications in critically ill adult patients. Heart Lung 2020;49:774-8. doi: 10.1016/j.hrtlng.2020.09.016, PMID 32979642

Thakore S, Kundra P, Garg R. A descriptive survey of tracheal extubation practices among Indian anaesthesiologists. Indian J Anaesth 2021;65:210-5. doi: 10.4103/ija.IJA_948_19, PMID 33776111

Lakhe G, Pradhan S, Dhakal S. Hemodynamic response to laryngoscopy and intubation using McCoy laryngoscope: A descriptive cross-sectional study. JNMA J Nepal Med Assoc 2021;59:554-7. doi: 10.31729/jnma.6752, PMID 34508397

Fang B, Ma H. Ventricular arrhythmia during tracheal intubation and extubation under general anesthesia possibly induced by amisulpride: A case report. Clin Psychopharmacol Neurosci 2018;16:358-60. doi: 10.9758/cpn.2018.16.3.358, PMID 30121989

Benson CD, Goodrow MS, Loyd GE. Development of a sympathetic response to laryngoscopy and endotracheal tube placement in a patient simulator. Simul Healthc 2006;1:35-43. doi: 10.1097/01266021- 200600110-00004, PMID 19088572

Andersen LW, Granfeldt A, Callaway CW, Bradley SM, Soar J, Nolan JP, et al. Association between tracheal intubation during adult in-hospital cardiac arrest and survival. JAMA. 2017;317:494-506. doi: 10.1001/jama.2016.20165, PMID 28118660

Seet E, Zhang J, Macachor J, Kumar CM. Choosing the best supraglottic airway for ophthalmic general anaesthesia: A manikin study. J Clin Monit Comput 2021;35:443-7. doi: 10.1007/s10877-020-00507-w, PMID 32274646

Teong CY, Huang CC, Sun FJ. The haemodynamic response to endotracheal intubation at different time of fentanyl given during induction: A randomised controlled trial. Sci Rep 2020;10:8829. doi: 10.1038/s41598-020-65711-9, PMID 32483139

Lim H, Kim JH, Kim D, Lee J, Son JS, Kim DC, et al. Tracheal rupture after endotracheal intubation-a report of three cases. Korean J Anesthesiol 2012;62:277-80. doi: 10.4097/kjae.2012.62.3.277, PMID 22474557

Ozhan MO, Eskin MB, Atik B, Suzer MA, Capalar CO. Laryngeal mask airway for general anesthesia in interventional neuroradiology procedures. Saudi Med J 2019;40:463-8. doi: 10.15537/ smj.2019.5.24131, PMID 31056623

Hegde HV, Bandi J, Mudakanagoudar MS, Honnannavar KA. Evaluation of performance of streamlined liner of the pharynx airway™, laryngeal mask airway-ProSeal and endotracheal tube in prone position: A prospective, randomised study. Indian J Anaesth 2018;62:173-81. doi: 10.4103/ija.IJA_691_17, PMID 29643550

Ubale P, Jadhav A. An observational study to evaluate the haemodynamic changes between endotracheal intubation and laryngeal mask airway insertion. Int J Contemp Med Res 2020;7:D5-10. doi: 10.21276/ ijcmr.2020.7.4.18

Obsa MS, Sholla AL, Baraki BG, Welde GD, Gelgelu TB, Kuruche MM. Effect of laryngeal mask air way insertion versus endotracheal intubation over hemodynamic responses in pediatrics patient who underwent ophthalmic surgery at Menelik II hospital, Addis Ababa: A prospective observational study design. Anesthesiol Res Pract 2020;2020:7021641. doi: 10.1155/2020/7021641, PMID 32565787

Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth 1987;59:295-9. doi: 10.1093/bja/59.3.295, PMID 3828177

Suppiah RK, Rajan S, Paul J, Kumar L. Respiratory and hemodynamic outcomes following exchange extubation with laryngeal mask airway as compared to traditional awake extubation. Anesth Essays Res 2016;10:212-7. doi: 10.4103/0259-1162.174469, PMID 27212749

Peirovifar A, Eydi M, Mirinejhad MM, Mahmoodpoor A, Mohammadi A, Golzari SE. Comparison of postoperative complication between laryngeal mask airway and endotracheal tube during low-flow anesthesia with controlled ventilation. Pak J Med Sci 2013;29:601-5. doi: 10.12669/pjms.292.2980, PMID 24353586

Van Esch BF, Stegeman I, Smit AL. Comparison of laryngeal mask airway vs tracheal intubation: A systematic review on airway complications. J Clin Anesth 2017;36:142-50. doi: 10.1016/j. jclinane.2016.10.004, PMID 28183554