Effect of awake tracheal intubation with intubating larynegeal mask airway on stress responses of hypertensive patients

Abstract

Objective To evaluate the effect of awake tracheal intubation with intubating larynegeal mask airway(ILMA)on stress responses of hypertensive patients. Methods Sixty hypertensive patients, aged 45-64 yr, with body mass index of 20.3-27.5 kg/m2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, undergoing elective abdominal surgery under general anesthesia, were divided into 2 groups(n=30 each)using a random number table: direct laryngoscope group(group D)and ILMA group(group I). At 3 min after topical anesthesia(T1), while epiglottis and glottis were exposed with direct laryngoscope in group D or during ILMA insertion in group I(T2), immediately after completion of intubation(T3), when the maximum change in hemodynamics after intubation appeared(at about 15 s after tracheal tubes were placed, T4), and at 5 min after completion of intubation(T5), mean arterial pressure(MAP)and heart rate(HR)were recorded, and blood samples were collected for determination of plasma epinephrine concentrations by radio-immunity method.Successful intubation at first attempt was recorded. Results Compared with the parameters at T1, the MAP, HR and plasma epinephrine concentrations were significantly increased at T2-4 in group D(P 0.05). Compared with group D, the MAP, HR and plasma epinephrine concentrations were significantly decreased at T2-4(P 0.05). Conclusion Awake tracheal intubation with ILMA does not induce strong stress responses and is helpful in avoiding the occurrence of cerebrovascular accidents, thus increasing the safty of awake tracheal intubation in hypertensive patients. Key words: Hypertension; Laryngeal masks; Intubation, intratracheal