title: Cardiovascular responses to tracheal extubation or LMA removal in normotensive and hypertensive patients.
abstract: OBJECTIVE
  This study was undertaken to evaluate the haemodynamic changes of tracheal extubation or removal of a laryngeal mask airway (LMA) in normotensive and hypertensive patients.
  
  
  METHODS
  In a randomized trial of normotensive and hypertensive patients (n = 40 of each), tracheal extubation or LMA removal was performed. Changes in heart rate (HR), mean arterial pressure (MAP) and rate-pressure product (RPP) were measured before and 1, 2, 3, 5, and 10 min after tracheal extubation or LMA removal.
  
  
  RESULTS
  In normotensive patients, HR, MAP and RPP increased following tracheal extubation or LMA removal, and remained elevated for a maximum three minutes (P < 0.05). In hypertensive patients, the haemodynamic increases in response to extubation or LMA removal were observed for up to five minutes (P < 0.05). The immediate cardiovascular responses to extubation were greater than those related to LMA removal in both normotensive and hypertensive patients (normotensive: HR; 95 +/- 14 vs 81 +/- 11, MAP; 124 +/- 18 vs 106 +/- 10, RPP; 14,951 +/- 2720 vs 10,654 +/- 1898, hypertensive: HR 105 +/- 10 vs 87 +/- 13, MAP; 146 +/- 17 vs 119 +/- 12, RPP; 20,492 +/- 1674 vs 12,862 +/- 2115, mean +/- SD, P < 0.05). Following extubation or LMA removal, these haemodynamic variables increased more markedly in hypertensive patients than in normotensive patients (P < 0.05).
  
  
  CONCLUSIONS
  Removal of LMA is associated with less cardiovascular change than tracheal extubation in both normotensive and hypertensive patients.
authors.affiliation: Department of Anaesthesiology, University of Tsukuba Institute of Clinical Medicine, Ibaraki, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Fujii
authors.forename: H
authors.initials: H
authors.lastname: Toyooka
authors.forename: H
authors.initials: H
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D007432:Intraoperative Period; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D017214:Laryngeal Masks; D008297:Male; D008875:Middle Aged