title: Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway.
abstract: OBJECTIVE
  We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients.
  
  
  METHODS
  Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded.
  
  
  RESULTS
  The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04 ± 19.8 s, respectively) (p<0.001). The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05). The rate pressure product values (heart rate x systolic blood pressure) at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively) were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively) (p<0.05). There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754). The number and type of airway complications were similar between the groups.
  
  
  CONCLUSIONS
  The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from conventional laryngoscopy in hypertensive patients. As ST changes and upper airway morbidity are similar between the two techniques, conventional laryngoscopy, which is rapid and safe to perform, may be preferred in hypertensive patients with normal airways.
authors.affiliation: Ondokuz Mayis University, Faculty of Medicine, Department of Anesthesiology, Kurupelit/Samsun, Turkey. bengimd@hotmail.com
authors.forename: Elif Bengi
authors.initials: EB
authors.lastname: Sener
authors.forename: Emre
authors.initials: E
authors.lastname: Ustun
authors.forename: Burcu
authors.initials: B
authors.lastname: Ustun
authors.forename: Binnur
authors.initials: B
authors.lastname: Sarihasan
mesh_terms: D000402:Airway Obstruction / Q000453:epidemiology* / Q000209:etiology; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology* / Q000628:therapy; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods; D017214:Laryngeal Masks / Q000009:adverse effects*; D007828:Laryngoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors