COMPARATIVE EVALUATION OF HAEMODYNAMIC RESPONSE AT EXTUBATION BETWEEN TRACHEAL TUBE AND BAILEY'S MANOEUVRE USING i-gel® IN ADULT PATIENTS WITH CONTROLLED HYPERTENSION FOR ELECTIVE SURGERY

Abstract

Background and Aims: Airway instrumentation leads to haemodynamic disturbances like rise in heart rate, blood pressure and risk of cardiac arrhythmias. These changes are seen more in hypertensive patients sometimes leading to serious consequences. This study evaluates and compares the changes in haemodynamic parameters (Heart Rate, Blood Pressure) in standard tracheal extubation and in Bailey's manoeuvre using i-gel ® in adult patients with controlled hypertension. Materials and methods: Sixty American Society of Anaesthesiologists (ASA) physical status II adult patients (controlled hypertensives) undergoing general anaesthesia were randomised into group E (n = 30) and group I (n = 30). In Group E endotracheal extubation was performed by employing the standard technique of extubation and in Group I Bailey's manoeuvre was employed using i-gel®. All haemodynamic data was measured on arrival in operation theatre i.e. baseline, before extubation, after extubation at 1, 3, 5, 7 and 9 min by an independent observer. Results: Both endotracheal extubation and Bailey's manoeuvre were associated with rise in Heart Rate (HR), Blood Pressure (Systolic, Diastolic and Mean Arterial Pressure) when compared with baseline values. This rise was observed higher in group E (endotracheal extubation) as compared to Group I (Bailey's manoeuvre). The percentage increase in HR, Systolic Blood Pressure, Diastolic Blood Pressure and Mean Arterial Pressure parameters was seen maximal at 1 minute after extubation than at 3 minutes, 5 minutes, 7 minutes and 9 minutes. The rise in HR at one minute of extubation was signicantly higher (p value 0.046) in E group than I group. The rise in blood pressure was also more in E group than I group but it was not statistically signicant. Conclusion: Bailey's manoeuvre using i-gel ® attenuates the increase in heart rate when compared to endotracheal extubation but it insufciently mitigates the increase in blood pressure.