Hemodynamic and catecholamine stress responses to insertion of the combitube as an alternative airway management in general anaesthesia for caesarean section

ABSTRACT

The introduction of Combitube to the field of airway management brought about a solution of the problem of difficult airway in trauma patients and during cardiopulmonary resuscitation. This trial was designed to assess the efficacy of Combitube in preventing the lethal complications of failed Intubation during caesarean section and compare the haemodynamic and stress response to the device with that resulting from endotracheal intubation. Forty-five healthy parturients scheduled for CS were randomized Into three equal groups. Combitube was inserted blindly in group I and facilitated by laryngoscopy in group II In group III, endotracheal intubation was performed under laryngoscopy. Patients were assessed for the degree of difficulty of insertion of the Combitube, manifestation of regurgitation or trauma to the oropharynx. haemodynamic changes and hormonal response to Combitube Insertion and endotracheal intubation. There was no significant difference in the degree of ease on Introduction of Cornbitube in group I as compared to group II. Combitube proved to be a safeguard against regurgitation as group I and II were compared to group III A high incidence of trauma was noticed in group I during blind insertion of Combitube as compared to laryngoscopy aided insertion in group II or endotracheal Intubation in group III Laryngoscopy aided Insertion of Combitube [group II] or endotracheal intubation [group III] produced a significant increase In heart rate as compared to blind insertion in group I. Comparison between groups II and III showed a significant increase In HR in group III. Systolic blood pressure Increased significantly in group III while the other two groups manifested an insignificant increase. Stress hormones manifested increases in all the groups. Nor- adrenaline level increased insignificantly in group I and II. while it was statistically significant In group III. Adrenaline levels increased insignificantly in all the study groups. Prolactine level increased insignificantly In group I and manifested a significant increase in groups II and III. This Increase was significantly higher in group III as compared to group II. It is concluded that Combitube provides a safe patent airway not only in emergency situations but also in patients scheduled for surgery if they were at risk of aspiration or difficult intubation as those scheduled for caesarean section