Comparative study of hemodynamic changes using proseal laryngeal mask airway, intubating laryngeal mask airway or laryngoscopic endotracheal intubation under general anesthesia in patients undergoing coronary artery bypass grafting surgery

Introduction: Laryngoscopy and endotracheal intubation alter cardiovascular physiology both via reflex responses and physical presence of an endotracheal tube (ETT). Stress response caused by laryngoscopic endotracheal intubation may be harmful for the coronary or cerebral circulation of high-risk patients. This study aimed to evaluate the hypothesis that placement of Proseal laryngeal mask airway (PLMA) and intubating laryngeal mask airway (ILMA) are associated with less cardiovascular response than the endotracheal intubation via conventional technique. Materials and Methods: In this hospital-based, randomized, interventional study, 105 patients of the American Society of Anesthesiologists Grade II and III undergoing coronary artery bypass grafting surgery under general anesthesia were randomly allocated into three groups, that is, PLMA, ILMA, and ETT. Hemodynamic parameters such as heart rate, blood pressure, cardiac output, cardiac index, systemic vascular resistance (SVR,) and SVR index baseline, during induction and after insertion of device were compared. Results: The study groups were comparable with respect to age, weight, height, gender, and baseline hemodynamic parameters. The heart rate, systolic blood pressure, diastolic blood pressure, and MAP were significantly higher (P < 0.05) in endotracheal group as compared to PLMA and ILMA groups for 15 min following intubation, that is, throughout the study period. However, there was no significant difference between PLMA and ILMA group (P > 0.05). SVR was significantly higher in endotracheal group as compared to PLMA and ILMA group throughout the study (P < 0.05). The cardiac index at all time was not significantly different among the three groups. Conclusion: PLMA and ILMA insertion is accompanied by minimal cardiovascular responses than those associated with direct laryngoscopic endotracheal intubation, so it can be used for patients in whom a marked pressor response would be deleterious.