Key result
The use of a ProSeal laryngeal mask airway significantly attenuated hemodynamic stress, resulting in a lower mean systolic blood pressure (134.8 vs 146.7 mmHg) compared to an endotracheal tube in cardiac compromised patients.
Why the study?
Does ProSeal laryngeal mask airway (PLMA) improve hemodynamic stability compared to endotracheal tube (ETT) in cardiac compromise patients (LVEF <45%) undergoing laparoscopic cholecystectomy?
RCT (n=60)
Coin flip
No
Does ProSeal laryngeal mask airway (PLMA) improve hemodynamic stability compared to endotracheal tube (ETT) in cardiac compromise patients (LVEF <45%) undergoing laparoscopic cholecystectomy?
Absolute Event Rate: 134.785% vs 146.675%
p-value: p=0.023
In patients with LVEF <45% undergoing laparoscopic cholecystectomy, the use of a ProSeal laryngeal mask airway significantly attenuates the hemodynamic stress response compared to endotracheal intubation.
Supports PLMA over ETT to blunt hemodynamic stress in LVEF<45% laparoscopic patients; extends RCT evidence for airway choice in cardiac compromise.
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
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Rahman et al. (2018) conducted an RCT in Cardiac compromise with LVEF < 45% undergoing laparoscopic cholecystectomy (n=60). ProSeal laryngeal mask airway (PLMA) vs. Endotracheal tube (ETT) was evaluated on Mean systolic blood pressure at 3 minutes after insertion (mmHg) (p=0.023). The use of a ProSeal laryngeal mask airway significantly attenuated hemodynamic stress, resulting in a lower mean systolic blood pressure (134.8 vs 146.7 mmHg) compared to an endotracheal tube in cardiac compromised patients.
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