A RANDOMIZED CLINICAL TRIAL OF COMPARISON OF PRESSOR RESPONSES DURING AND AFTER TRACHEAL EXTUBATION AND LMA (LARYNGEAL MASK AIRWAY) REMOVAL IN CONTROLLED HYPERTENSIVE PATIENTS

Dr.Murali Prabhakar; Dr. Raghu Praveen Kumar

Volume : V, Issue : II, February - 2015

A RANDOMIZED CLINICAL TRIAL OF COMPARISON OF PRESSOR RESPONSES DURING AND AFTER TRACHEAL EXTUBATION AND LMA (LARYNGEAL MASK AIRWAY) REMOVAL IN CONTROLLED HYPERTENSIVE PATIENTS

Dr. Murali Prabhakar, Dr. Raghu Praveen Kumar

Abstract :

Context: A Randomized clinical trial Of pressor responses during and after tracheal extubation and LMA (Laryngeal Mask Airway) removal in controlled hypertensive patients. AIM: aim of our study was to compare the pressor responses during and after tracheal extubation and LMA (Laryngeal Mask Airway) removal in controlled hypertensive patients. Settings and Design: The present prospective study was carried out in a territory care Teaching hospital. A total of 80 ASA–II controlled hypertensive patients undergoing elective Surgical procedure under general anaesthesia. The patients were randomly divided to two Groups, Group “T” (endotracheal) and group “L” (Laryngeal Mask Airway) with 40patients in each group. Materials and Methods: All the patients received 5mg alprazolam orally night before surgery. Inj Ondansetron 4mg IV inj glycopyrrolate 0.005mgkg–1 and inj ranitidine 50mg I.V were administered 60minutes before surgery. Once the patient was shifted to the operation theater pulse rate and blood pressure noted pre–oxygenation done with 100% oxygen for 5 minutes and thiopentone was given until eye lash reflex disappeared and intubation was facilitated with succinylecholine anaesthesia was maintained with oxygen (50%) nitrous oxide (50%) + sevoflurane (0.5%) and vecronieum omide 0.1mg / kg. at the end of procedure patients were reversed with Glycopyrrolate 0.01mg /kg and neostigmine 0.05mg /kg – iv. Endotracheal and Laryngeal Mask Airway removal was carried out when patient was completely conscious and response to verbal commands. Pulse rate blood pressure were recorded during pre induction, just before extubation and Larnygeal Mask Airway removal 1,2,3,5 and 10min after extubation, rate pressure product and mean arterial pressure at those interval were calculated Statistical Analysis Used: Comparibility of groups are analyzed by students “t” test P<0.05 was considered as statistically significant. Results: From this study we have observed that Both endotracheal extubation and laryngeal mask airway removal were associated with a statistically significant rise in pulse rate, rate pressure product and mean arterial pressure when compared with baseline values. The rise was significantly higher in the extubation group as compared to laryngeal mask airway removal group. The values did not returned to baseline values even after 10minutes of extubation, whereas in laryngeal mask group the haemodynamic values returned to baseline levels, 5 minutes after LMA removal. Conclusion: The conclusions drawn from this study are that in controlled hypertensive patients, the haemodynamic responses produced by laryngeal mask airway removal are lesser and short lived as compared to endotracheal extubation. Use of Laryngeal mask airway is quite advantageous in hypertensive patients where in there is a concern about the pressor responses due to airway instrumentations.