Title: Comparison of hemodynamic and Ventilator parameters with i-gel vs endotracheal tube in patients for laparoscopic cholecystectomy
Authors: Dr Bhawna Ahluwalia, Dr Manjit Singh Kanwar, Dr Ankita Chandel, Dr Nisha Sharma, Dr Naresh Anand
DOI: https://dx.doi.org/10.18535/jmscr/v9i2.02
Abstract
Laparoscopic surgery or minimal invasive surgery is an evolving surgical specialty in view of number of advantages like minimal bleeding, small incision, less surgical scar and short recovery time. It is done with insufflation of carbondioxide in the peritoneal cavity leading to increased abdominal pressure, raised carbon-dioxide levels, hemodynamic changes or lung aspiration.(1) Till date cuffed endotracheal tubes are used to secure the airway and adequate control of airway pressures but the airway manipulation during laryngoscopy and ventilation leads to sympatho-adrenal axis stimulation that can cause increase in heart rate, blood pressure, increased myocardial contractility, increased myocardial oxygen demand, myocardial ischemia or infarction, increased intracranial pressures or bronchospasm. To combat these effects we used laryngeal mask airway to secure the airway and control of ventilation during laparoscopic cholecystectomy.
Methodology: A total of 80 patients of ASA-1 &2 selected for this double blind, prospective, randomised study. They were divided into two groups; group I and group E, of 40 each. Group-I was managed by LMA (i-gel) and Group-E by endotracheal cuffed tube. A detailed pre-anesthesia check up done for all the patients and informed consent taken. All patients who fulfilled the inclusion criteria were kept nil orally for six hours before the surgery and anaesthesia. Pre-medication given with cap pantoprazole 40mg night before the surgery and at 6.0am on the day of surgery. In the operation theatre after recording the baseline vital parameters all patients induced and airway device was used as per their group. Any changes in the heart rate, blood pressure, airway pressures recorded and compared. Incidence of post-operative throat discomfort or Sore throat also noted down.
Results: The number of attempts taken to place the i-gel or endotracheal tube was not significant but the duration of time to place the i-gel v/s ETT was quite less…..14.98 v/s 19.23 sec ( p-value =< 0.05).A significant increase in the heart rate and blood pressure at the time of endotracheal intubation in group- E patients from a baseline of 74.10 to 82.30 compare to group-I that varied from 74.10 to 75.15 maximum(p-value <0.05). The mean blood pressure was 123.33 mmhg in group I and 124.10mmhg in group E.A significant rise in Sysolic and diastolic Blood Pressure is seen at at 1 and 5 minutes in group E and a similar trends seen in extubation. (p --0.05). No significant differences recorded in the mean airway pressure in both the groups before, during and after the pneumoperitoneum (p-- >0.05).
Conclusion: Use of i gel-LMA is better tolerated by the patient in terms of hemodynamic stability, airway pressures and post-operative comfort.
Keywords: Laparoscopy, laryngeal mask airway, cholecystectomy.
