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Haemodynamic Effects of LMA Fastrach versus Macintosh Laryngoscope While Intubation in Patients Undergoing Cabg

Renuka R., Assistant Professor, Department of Anaesthesiology, Sapthagiri Institute of Medical Sciences & Research Centre, Bangalore. , Vanita1 , Renuka R.2

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Indian Journal of Anesthesia and Analgesia 5(9):p 1564-1571, September 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5918.22

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Abstract

Coronary artery bypass grafting (CABG) surgery is still the predominant operative procedure for myocardial revascularization. The pressor response to intubation is a detrimental factor in these patients, where stable hemodynamics is desired. Use of various intubation aids, is one of the methods by which this could be minimised. Hence, we decided to compare the haemodynamic changes to endotracheal intubation after conventional laryngoscopy versus the use of intubating laryngeal mask airway. We also aimed at comparing the ease of intubation and the complications of the above two intubation methods.

Methods: Prospective, randomized, double blinded study in 60 patients between 30-75 yrs age group of either gender, scheduled for elective CABG surgery. patients were evaluated preoperatively and were randomly allocated into group I & group II consisting of 30 patients each using computer generated numbers. General anaesthesia administered and for patients in group I ILMA was used and in group II conventional laryngoscopy and endotracheal intubation was done. Haemodynamic parameters (blood pressure, heart rate, ST segment analysis)were recorded at different time intervals and the occurrence of adverse events such as oxygen desaturation and soft tissue trauma was also noted.

Results: The time taken for intubation (represented as Mean SD) was found to be 108.5 (± 36.8) seconds in group I, 22.5 (±11.7) seconds in group II with a p value of 0.0001. There was no statistically significant changes in the haemodynamic parameters (heart rate, blood pressure, ST segment changes) between both the groups. However, statistically significant intragroup comparisons were found. The incidence of intraoperative complications was found to be 6.6% in group I and 3.3% in group II. Thus we concluded that, intubation through intubating laryngeal mask airway takes more time than conventional laryngoscopy and endotracheal intubation but offers no advantage when stress response to intubation is concerned in patients undergoing CABG.

 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5918.22

Keywords

Coronary Artery Bypass Grafting; Intubating Laryngeal Mask Airway; Macintosh Laryngoscope Blade; Pressor Response; Wilcoxon Ranksum Test.

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