A randomized comparative study of intraocular pressure and hemodynamic changes on insertion of proseal laryngeal mask airway and conventional tracheal intubation in pediatric patients

Agrawal, Garima; Agarwal, Munisha; Taneja, Saurabh

doi:10.4103/0970-9185.98325

Cited by 25 publications

(24 citation statements)

References 10 publications

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“…The most important part related to proper control of IOP is likely related to nonperforming laryngoscopy. [12] This study aimed to investigate hemodynamic changes and IOP in the patients undergoing elective cataract surgery after intubation of an ETT, LMA, and I-gel.…”

Section: Research Articlementioning

confidence: 99%

Untitled

Akhondzade¹

2017

AJP

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Background and Objective: Hemodynamic changes following laryngoscopic tracheal intubation can trigger catecholamine release which consequently increases blood pressure and intraocular pressure (IOP) resulting in the disc rupture and ultimately blindness. Endotracheal intubation (endotracheal tube [ETT]) is a common technique for stress response management. The present study aims to comparatively investigate the hemodynamic changes and IOP after three intubation approaches of ETT, laryngeal mask airway (LMA) Classic™, and I-gel in patients undergoing elective cataract surgery. Materials and Methods: This clinical trial was conducted on 75 patients with ASA classes I and II (age range: 50-65 years old) who were the candidate for elective cataract surgery admitted in Ahvaz Imam Hospital, Iran, during 2013-2014. The hemodynamic changes and IOP values were measured in the patients before and after intubation with ETT, LMA Classic™, and I-gel. The pulse rate, systolic and diastolic blood pressures, and IOP were measured at four intervals at 1 minute before and at 1, 2, and 5 min after the insertion of the airway devices. The IOP was measured with Tonopen. Results: Immediately, before inserting ETT, LMA, and I-gel, the heart rate, systolic and diastolic blood pressures significantly increased in all groups. The results showed that the hemodynamic changes and IOP following I-gel were more stable than the LMA Classic™ and ETT devices. In addition, the LMA Classic™ intubation showed more stable hemodynamic response than the ETT. Conclusions: The findings showed that I-gel intubation results in more stable hemodynamic responses in elective cataract surgery.

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Section: Research Articlementioning

confidence: 99%

Untitled

Akhondzade¹

2017

AJP

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“…Agrawal G et al reported that there was signifi cantly high rise in heart rate and mean arterial pressure from base line in paediatric patients with use of LMA and tracheal tube 2 . There was signifi cant increase in heart rate and blood pressure in tracheal tube group compared to LMA group of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Despite use of strong opioids, adequate anaesthetic depth and application of other stress reducing techniques and agents, there is release of catecholamines and cortisol which causes increase in heart rate and pressor response after pharyngeal and laryngotracheal manipulation, usually more after laryngoscopy and tracheal intubation 2,5,6 .…”

Section: Introductionmentioning

confidence: 99%

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The haemodynamic and ventilatory responses with I-gel, laryngeal mask airway and tracheal intubation during laparoscopic cholecystectomy

Maharjan

2013

J. Kathmandu Med. Coll.

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Background: Despite use of adequate medications and techniques, tracheal intubation induces haemodynamic stress response, which can be minimized by using supraglottic airway devices instead of tracheal tube in elective surgical cases with adequate oxygenation and ventilation. Objectives: To compare haemodynamic variables and ventilation parameters of I-gel and laryngeal mask airway with tracheal intubation during laparoscopic surgery. Methods: This is a prospective randomized comparative study among 90 cases of American Society of Anesthesiologists physical status class I and II, undergoing laparoscopic cholecystectomy, who were equally divided into three groups of 30 patients each: I-gel group, Laryngeal mask airway group and Tracheal tube group. Randomization was done with pick up of cards from sealed envelope. Basal readings of heart rate, systolic, diastolic and mean arterial pressure were recorded and these parameters were measured again before airway device placement, one, three and fi ve minutes after airway manipulation, during carboperitoneum creation and before and after extubation. Oxygen saturation, end tidal CO 2 , airway pressure and inhaled and exhaled tidal volume and minute volume were monitored before, during and after carboperitoneum creation. Leak volume was calculated by deducing exhaled tidal volume from inhaled tidal volume. Statistical analysis (Analysis of variance test) was done to see the differences among the groups. Results: Haemodynamic perturbations were maximum with tracheal intubation and moderate with laryngeal mask airway while stable haemodynamics was observed with I-gel. Intra and inter-group comparison revealed signifi cant differences after use of airway devices and after removal as well. Regarding ventilatory response, oxygenation and ventilation was well maintained with maximum airway pressure of mean ± SD: 20.11 ±3.46, 20.24 ±4.42, 19.05±4.82 cmH 2 O during carboperitoneum creation in I-gel, laryngeal mask airway and tracheal tube group respectively and oxygen saturation of 98 to 100% and end tidal CO 2 level of 31-35 mmHg. In all groups, minute volume was well maintained and leak volume of 18.88±12.40, 17.13±13.32 and 20.89±12.20 ml were recorded in I-gel, laryngeal mask airway and tracheal tube group respectively during carboperitoneum creation. There was no statistically signifi cant difference among the groups at any time regarding the monitored parameters. Conclusion: Among the three airway management devices used during general anaesthesia with positive pressure ventilation, I-gel produced least haemodynamic stress response, both supraglottic devices can be used with proper size and placement with acceptable haemodynamics and ventilation during laparoscopic surgery.

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“…Compared to tracheal intubation and extubation, the use of SADs is associated with more stability in hemodynamics, 15 intracranial pressure, 16 and intraocular pressure. [17][18][19] There is a lower incidence of emergence cough and postoperative sore throat with SADs. A previous metaanalysis showed 17% incidence of sore throat with the LMA Classic compared with 39% incidence after tracheal intubation.…”

Section: Alternative To Tracheal Intubation For Routine Anesthesiamentioning

confidence: 99%

Supraglottic Airway DevicesDiscussion

Ramachandran

Kumar

2014

Respir Care

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SummarySupraglottic airway devices (SADs) are used to keep the upper airway open to provide unobstructed ventilation. Early (first-generation) SADs rapidly replaced endotracheal intubation and face masks in > 40% of general anesthesia cases due to their versatility and ease of use. Second-generation devices have further improved efficacy and utility by incorporating design changes. Individual second-generation SADs have allowed more dependable positive-pressure ventilation, are made of disposable materials, have integrated bite blocks, are better able to act as conduits for tracheal tube placement, and have reduced risk of pulmonary aspiration of gastric contents. SADs now provide successful rescue ventilation in > 90% of patients in whom mask ventilation or tracheal intubation is found to be impossible. However, some concerns with these devices remain, including failing to adequately ventilate, causing airway damage, and increasing the likelihood of pulmonary aspiration of gastric contents. Careful patient selection and excellent technical skills are necessary for successful use of these devices.

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A randomized comparative study of intraocular pressure and hemodynamic changes on insertion of proseal laryngeal mask airway and conventional tracheal intubation in pediatric patients

Cited by 25 publications

References 10 publications

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The haemodynamic and ventilatory responses with I-gel, laryngeal mask airway and tracheal intubation during laparoscopic cholecystectomy

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