Cardiovascular Response to Insertion of Laryngeal Mask in Hypertensive Patients

Park, Young Chul; Lim, Sang Ho; Kim, Nan Sook; Lee, Il Ok; Lee, Mi Kyung

Abstract

The adverse cardiovascular effects of laryngoscopy and endotracheal intubation are well known. In marked contrast, insertion of the laryngeal mask is associated with cardiovascular stability. We undertook this study to investigate this observation of hypertensive patients (World Health Organization has defined hypertension as systolic blood pressures above 160 mmHg and/or diastolic blood pressures greater than 95 mmHg). Forty patients undergoing gynecological procedures were anesthetized and airway was maintained with either the endotracheal intubation(n=20) or insertion of laryngeal mask(n=20). They received thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg intravenously for induction. Blood pressure and pulse rate were measured immediately pre-induction control value, post-intubation or post-insertion of laryngeal mask 1 minute, 2 minute, 3 minute, 5 minute. All measurements were made with a Criticon Dinamap oscillotonometric device. After direct laryngoscopy and endotracheal intubation, systolic blood pressure increased significantly(p<0.05) by 12% from control values and heart rate increased 10% from control values significantly(p<0.05). After insertion of the la- ryngeal mask, the systolic blood pressure decreased significantly by 14% from control values(p <0.05) and heart rate decreased 6.6% from eontrol values. We believe that the ability to gain control of the airway without subjecting the hypertensive patients to the stress of laryngosco- py and endotracheal intubation is a great advantage of the laryngeal mask, especially in patients most at risk-those with hypertension and/or coronary or cerebrovascular disease.