Résumé
Endotracheal intubation is one of the most invasive stimuli in anaesthesia1 producing noxious haemodynamic response in the form of tachycardia, hypertension and increased stress hormones i.e., catecholamine levels.1 This airway stimulus may increase morbidity and mortality in patients with recent myocardial infarction, hypertension, preeclampsia and cerebrovascular pathology such as tumours, aneurysms etc. Many pharmacological and non-pharmacological methods have evolved over time to obtund these haemodynamic stress responses to laryngoscopy and intubation. One such method is the use of Intubating Laryngeal Mask Airway (ILMA). In the present study, we compared changes in haemodynamic responses during intubation with endotracheal tube versus intubating with laryngeal mask airway. METHODSFifty patients of either sex between 15-45 years were randomized in to two groups. Group I for ILMA (n=25) and group II for Laryngoscopy and endotracheal intubation (n=25). Hemodynamic responses such as heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) were measured in either groups and compared at just before induction which was used as baseline, after intubation through ILMA/Laryngoscopy and at the end of 1, 2, 3, 5 and 10 minute intervals.RESULTSBoth intubation through ILMA and laryngoscopy insertion were associated with increase in HR, SBP and DBP but in Group II Laryngoscopy group, the increase was 46.09%, 24.28% and 26.00% from baseline. The rise in HR, SBP and DBP were statistically significant (p<0.05) just after intubation through ILMA/laryngoscopy, it remained significant in the post intubation period till 5 minutes. After 5 and 10 minutes the changes in HR, SBP and DBP were not significant (p>0.05) between the groups.CONCLUSIONSIn Group I ILMA insertion was carried out easily and laryngoscopy was not needed. ILMA insertion was associated with an attenuated pressor response in comparison with laryngoscopy and intubation. In Group II there was higher increase in pressor response to intubation than Group I because laryngoscopy was done. Haemodynamic responses such as HR, SBP, DBP were significantly less following ILMA insertion as compared to direct laryngoscopy. So ILMA appears to be more suitable in patients where pressor response is to be avoided as in high risk patients i.e. h/o recent myocardial infarction, hypertension, CAD, preeclampsia and cerebrovascular pathology such as tumours, aneurysms etc.