A comparative study of cardiovascular response to laryngeal mask airway insertion and endotracheal intubation in elective surgery patients at the Kenyatta National Hospital

Abstract

Background: Tracheal intubation is a harmful stimulus that tends to provoke a marked sympathetic response manifested as tachycardia and hypertension which is predominantly deleterious in coronary or cerebral circulation of high risk patients. The LMA is designed primarily as a means of offering some of the advantafies of securing the airway while avoiding fundamental disadvantages of endotracheal intubation. In KNH we receive patients who suffer from hypertension, some form of cardiovascular and cerebrovascular disease. These groups of high risk patients require controlled hemodynamic variables peri-operatively in order to get a better outcome. Therefore, controlled hemodynamic response while securing the airway, is of great importance. Objective: The main objective was to evaluate cardiovascular responses to lMA insertion and compare them with those obtained during laryngoscopy and tracheal intubation in elective surgery patients at KNH. Methods: This is a prospective randomized observational study. 116 adult patients going in for elective surgery were recruited in the study. Patients were randomly allocated into two groups. Group I was managed using lMA appropriate for the estimated weight and group 2 was managed using laryngoscopy and tracheal intubation. Results: In this study no significant rise in HR was seen during lMA insertion and the rise in other parameters was not more than 7% as compared to En insertion where the percentage rise in parameters was at a range of 25-70%. The hemodynamic changes were also short lived in the lMA group compared to the En group. Conclusion: Therefore, where lMA is not contra- indicated, it should be recommended in conditions where a hyperdynamic response might be deleterious.