Haemodynamic Changes Associated with Tracheal Intubation Using Direct Laryngoscopyand Intubating Laryngeal Mask Airway: A Comparative Analysis

Résumé

Background: Haemodynamic changes can result from airway manipulations during direct laryngoscopy (DL) and endotracheal intubation and this may increase morbidity and mortality in patients. This can be attenuated either by medications or by modifying intubation techniques such as use of Intubating Laryngeal Mask Airway (ILMA) which can lessen hemodynamic responses. This study compares the hemodynamic responses during intubation by either DL or ILMA. Methodology: Eighty-six ASA I and II patients aged between 18-50 years scheduled for elective surgeries under general anaesthesia were randomized into two groups. Each received IV fentanyl 2μg/kg and glycopyrrolate 4μg/kg 4 minutes before induction with IV propofol 3mg/kg, followed by suxamethonium 2mg/kg to a maximum of 100mg to facilitate intubation. Forty-three patients in each group were intubated using either DL or ILMA. Anesthesia was maintained with isoflurane, muscle relaxation was with atracurium. At the end of the surgery patients were extubated following reversal of residual blockade. Hemodynamic parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP), and oxygen saturation (SpO2) at the immediate post-intubation period, then at 1st, 3rd, 5th,10th, 15th, 20th, 25th, and 30th minutes were assessed. Results: Baseline haemodynamic variables were comparable between the DL (88.28+12.19) and ILMA (90.79+10.71) groups. Mean heart rate ranged from 97.88 to 107.47 in the DL group and 104.98 to 115.28 for ILMA which were insignificant. MAP changes were also insignificant. There was a significant difference in the meantime for intubation between the DL (19.93 + 6.17)and ILMA groups (46.54 + 11.63) Conclusion: Haemodynamic responses were not both clinically and statistically significantly different when ILMA was compared with DL during endotracheal intubation following the use of propofol, fentanyl, and suxamethonium. The mean time for Intubation was significantly higher in the ILMA group.