B. Srinivas Rao1 , K. Nagarjun Reddy2 , Praveen Kumar Devulapalli3 , Raghu Praveen4 , M. Srinath5
The primary goal of an anaesthesiologist is to maintain a patent airway during general anaesthesia. Endotracheal intubation is considered as gold standard for securing an unobstructed airway. Endotracheal intubation and extubation cause reflex cardiovascular responses due to mechanical stimulation of the upper respiratory tract. Several methods have been used for attenuating these cardiovascular responses. Each method or drug that is used for attenuating these pressor responses has its own associated sequelae or disadvantages. Most certain method of avoiding adrenergic responses would be to avoid both laryngoscopy and endotracheal intubation. Use of laryngeal mask airway has also shown lesser haemodynamic response as no laryngoscopy is required for its placement. AIM: To compare the haemodynamic responses associated with laryngeal mask airway removal and endotracheal extubation in controlled hypertensive patients undergoing elective surgical procedures. DESIGN: A prospective randomized comparative study. METHODS: The study was conducted in eightycontrolled hypertensive patients in the age group 35-65 years belongs to ASA grade 1&2 scheduled for elective surgical procedure. Patients were allocated in a randomized manner by the envelop method, into two groups one undergoing endotracheal tube intubation (Group T) and other group undergoing laryngeal mask airway insertion (Group L). At the end of the procedure. Endotracheal extubation and laryngeal mask airway removal was carried out when patient was completely conscious and responded to verbal commands. Pulse rate and blood pressure were recorded for the study at the following intervals; A). Pre induction., B). Just before extubation or laryngeal mask removal (Baseline value), C). 1, 2, 3, 5 and 10 minutes after extubation., Rate pressure product and mean arterial pressure at those intervals were calculated. RESULTS: After airway instrumentation, in patients of group T, mean pulse rate, mean of mean arterial pressure and mean rate pressure product increased to a statistically significant levels above baseline and did not come back to baseline values even after 10 minutes of extubation. In patients of group L even though the rise was significant after instrumentation it came back to baseline values within 5 minutes post instrumentation. The rise was more significant in group T compared to group L. CONCLUSION: The conclusions drawn from this study are that in controlled hypertensive patients, the haemodynamic responses produced by laryngeal mask airway removal are lesser and short lived as compared to endotracheal extubation. Use of Laryngeal mask airway is quite advantageous in hypertensive patients where in there is a concern about the pressor responses due to airway instrumentations
