Use of Proseal Laryngeal Mask Airway (PLMA) and Endotracheal Tube (ETT) in Cardiac Compromise Patients with LVEF <45% Undergoing Laparoscopic Cholecystectomy : A Comparison of Hemodynamic Parameters

Abstract

Background: The major cause of sympatho-adrenal response to tracheal intubation is due to thestimulation of supraglottic region by tissue irritation induced by direct laryngoscopy. Direct laryngoscopyby activating proprioceptors, induces arterial hypertension, tachycardia and increased catecholamineconcentrationproportional to the intensity of stimulus exerted against the base of the tongue. Incardiac compromised patient, use of endotracheal tube (ETT) is associated with various hemodynamiccomplications, which are minimally affected during ProSeal laryngeal mask airway (PLMA) use.

Objective: This prospective study was conducted with the objective of demonstrating the advantages ofPLMA over ETT in the patients undergoing laparoscopic cholecystectomy surgeries.

Methodology: This prospective, interventional study was carried out in 60 patients who underwentlaparoscopic cholecystectomy surgeries. Patients were randomized in equal numbers to either ETTgroup or PLMA group, and various hemodynamic changes were observed at different time points.

Results: Patients in PLMA group had mean systolic blood pressure 134.785±03.765 mm Hg comparedto the patients of ETT group 146.675±05.764 mmHg. Pulse rate in the PLMA group was less (94.267 ±05.678per min) (P < 0.05) compared to ETT group (115.34±10.236).Thus, hemodynamic changes weresignificantly lower (P < 0.05) in PLMA than in ETT group. The incidence of adverse events was alsolower in PLMA group.

Conclusion: PLMA offers advantages over the ETT in airway management in the patients undergoinglaparoscopic cholecystectomy surgeries in cardiac compromise patients.

JBSA 2018; 31(1): 38-44