Original Research Article
Year: 2017 | Month: March | Volume: 7 | Issue: 3 | Pages: 14-21
Comparative Study of Pressor Responses after Tracheal Extubation and LMA (Laryngeal Mask Airway) Removal in Controlled Hypertensive Patients: A Randomised Clinical Trial
Dr Basheer Ahmed Khan1, Dr. Md Sirajuddin2, Dr Zara Batool2, Dr Unaiza2
1Professor and Head, 2Resident,
Department of Anesthesiology, Deccan College of Medical Sciences, Hyderabad, Telangana.
Corresponding Author: Dr. Md Sirajuddin
Background and objectives: Airway management using endotracheal intubation and laryngeal mask airway (LMA) are known to induce hemodynamic changes. The predominant response is tachycardia and systemic hypertension. The present study was undertaken to compare the hemodynamic responses after tracheal extubation and LMA removal in controlled hypertensive patients.
Methodology: The study was conducted on 70 patients in age group of 35-65 yrs, ASA Grade II scheduled for elective surgical procedures. Patients were allocated in randomized manner in two groups, one undergoing endotracheal tube intubation (Group T) and other undergoing laryngeal mask airway insertion (Group L). Each group had 35 patients. The hemodynamic data included pulse rate and blood pressure that were recorded at time intervals: baseline before intubation, at 1, 2, 3, 5 and 10 min after extubation or LMA removal. Rate pressure product was calculated.
Results: Extubation caused significant increase in mean pulse rate in Group T, which failed to reach baseline level after 10 minutes. LMA removal in Group L was associated with significant increase in mean pulse rate however it returned back to baseline at 5minutes after removal. Significant rise in MAP after extubation and LMA removal was observed in Group T and L, it did return to baseline values after 5 min in Group L and no such effect observed even after 10 min in Group T. Rise in mean pulse rate and mean arterial pressure was significantly higher when compared between group T and group L. Similar observations were made for rate pressure product in Group L and T respectively.
Interpretation and conclusion: Both endotracheal extubation and laryngeal mask airway removal were associated with a statistically significant rise in pulse rate, rate pressure product and MAP. The rise was significantly higher in Group T as compared to Group L. LMA removal was found to be accompanied with lesser pressor response as compared to endotracheal tube extubation in controlled hypertensive patients. Use of Laryngeal mask airway is quite advantageous and hence is desirable in hypertensive patients.
Key words: Controlled Hypertension, Laryngeal Mask Airway, Pressor Response, Tracheal Extubation.