BACKGROUND:When hip replacement patients treated with general anesthesia, intubation can cause physical stimulus of receptors of throat and trachea, which can increase stress response of patients, especial y in patients with hypertension. LMA Supreme laryngeal mask can lessen cardiovascular stress response of perioperative patients and reduce airway complications.
OBJECTIVE:To investigate the effects of Supreme laryngeal mask and endotracheal intubation on stress response of hypertensive patients with hip arthroplasty.
METHODS:A total of 45 patients treated with hip arthroplasty in the Shuyang Renci Hospital from January 2010 to September 2014 were enrol ed in this study. They were divided into laryngeal mask group (23 cases) and endotracheal intubation group (22 cases). The same protocol for induction and maintenance of general anesthesia was used in the two groups. During arthroplasty, systolic blood pressure, diastolic blood pressure, heart rate and blood oxygen saturation were monitored in patients. Systolic blood pressure, diastolic blood pressure, blood oxygen saturation, heart rate, blood glucose, plasma epinephrine, norepinephrine, serum cortisol, angiotensin II and atrial natriuretic factor levels were recorded before induction (T0), immediately (T1), 5 minutes (T2) and 15 minutes (T3) after intubation in the two groups.
RESULTS AND CONCLUSION:Systolic blood pressure and diastolic blood pressure were significantly reduced in the T1-T3 compared with T0 in the laryngeal mask group (P<0.05);blood oxygen saturation and heart rate were stable in T0-T3 (P>0.05). Systolic blood pressure and diastolic blood pressure were significantly increased at T1 compared with T0, systolic blood pressure was significantly reduced at T2 and T3 compared with T0, and diastolic blood pressure was significantly diminished at T 3 compared with T 0 in the endotracheal intubation group (P<0.05). Blood oxygen saturation and heart rate were significantly higher at T1 (P<0.05). Compared with endotracheal intubation group, systolic blood pressure and diastolic blood pressure were significantly lower at T 1-T 3 (P<0.05), and heart rate was significantly slower at T1 and T2 (P<0.05) in the laryngeal mask group. Blood oxygen saturation was significantly higher at T1 in the laryngeal mask group than in the endotracheal intubation group (P<0.05). Compared with T0, blood glucose, plasma epinephrine, norepinephrine and cortisol contents were significantly higher at T 1-T 3 in the endotracheal intubation group, and above indexes were higher in the endotracheal intubation group than in the laryngeal mask group (P<0.05). Angiotensin II levels were significantly higher at T1-T3 compared with T0 in the endotracheal intubation group, and it was significantly higher in the endotracheal intubation group than in the laryngeal mask group (P<0.05). Atrial natriuretic factor levels were increased at T 1-T 3 in the two groups, and it was significantly higher in the endotracheal intubation group than in the laryngeal mask group (P<0.05). These results confirm that laryngeal mask slightly impacted stress-related biochemical indicators, which is a physiological basis for slight effect of laryngeal mask on hemodynamics. Compared with endotracheal intubation, laryngeal mask obviously lessened stress reaction of hypertensive patients under general anesthesia treated with hip arthroplasty.