Abstract
Background: Direct laryngoscopy (DL) and intubating laryngeal mask airway (ILMA) are associated with varying degrees of stress response which is important particularly in patients with hypertension, as it may result in complications; as subendocardial ischemia, and cerebrovascular accidents.
The aim of the work: To compare intubation characteristics and stress responses during endotracheal intubation by intubating laryngeal mask airway versus Macintosh laryngoscope in controlled hypertensive patients.
Patients and methods: This prospective randomized study was carried out on 40 controlled hypertensive patients subjected to elective surgical procedures under general anesthesia at Zagazig University Hospitals. Patients were randomly assigned into two groups; DL group (n = 20) in which intubation was performed by Macintosh laryngoscope, and ILMA group (n = 20) in which intubation was performed via ILMA. Hemodynamics (heart rate, systolic blood pressure, and rate pressure product) were recorded before induction of anesthesia (baseline values), immediately after induction and at 1, 3, and 5 minutes after intubation. Serum cortisol and blood glucose levels were also recorded before induction of anesthesia (baseline values) and at 10 minutes after intubation.
Results: The hemodynamics were significantly higher in DL group than in ILMA group.
Also serum cortisol [169.65±28.89 ng/ml versus 149.7±21.49 ng/ml], and blood glucose levels [140.13±25.3mg/dl versus 117.82±18.44mg/dl] were significantly higher in DL group than in ILMA group.
Conclusion: ILMA was superior to Macintosh Laryngoscope in attenuation of stress responses to endotracheal intubation so, it is a preferable device for intubation in hypertensive patients.
Keywords: Intubating Laryngeal Mask Airway, Stress Response, Controlled Hypertension.