The Comparative Study Of Laryngeal Mask Insertion With Endotracheal Intubation On Hemodynamics Under BIS Monitoring

Objective: This study is mainly about the effects of placed SLIPA^TMlaryngeal mask in a different depth of anesthesia on hemodynamics andstress level. In order to reduce hemodynamic fluctuations and avoidanesthetic overdose,we explore the best anesthetic depth of SLIPA^TMlaryngeal mask placement to reduce anesthesia-related complications.Methods: We selected120patients of elective surgery for anesthesiaorbital disease.They were randomly divided into six groups, which werelaryngeal mask+BIS40group (A₁), laryngeal mask+BIS50group (A₂),laryngeal mask+BIS60group (A₃), trachea intubation+BIS40group(B₁), trachea intubation+BIS50, group (B₂), tracheal intubation+BIS60group (B₃) according to respiratory management approach and thebispectral index (BIS) values,respectively20cases in each group.Thegroup of B₁,B₂,B₃served as controls for A₁,A₂,A₃used same BISvalue.The pattern of anesthesia were all combined intravenous andinhalation anesthesia.The induction of anesthesia:Intravenous injectionof midazolam0.1mg/kg, the sufentanil0.4ug/kg, cis-atracurium amine0.1mg/kg, sustained constant speed input of propofol20mg/kg.h. WhenBIS values reached40,50,60, SLIPA^TM laryngeal mask or endotrachealintubation were placed and the dose of propofol are recorded.We usedsevoflurane, propofol and remifentanil to maintain intraoperativeanesthesia.The mean arterial pressure (MPA), hemodynamics, heart rate(HR), radial artery blood, blood glucose, Epinephrine (EP) andangiotensin â…¡ (Ang â…¡) levels were monitored and recorded at5-timing inburglary, intubation,1min,3min and5minutes after intubation(T₀, T₁,T₂, T₃, T₄). The data were analyzed by T test and χ2test by SPSS11.5 software. P＜0.05was considered statistically significant.Results:1Changes in hemodynamicsMAP in groups A₁and B₁at T₁decreased in comparison withT₀.Compared with T₁,MAP and HR in each group increased from T₂except groups A₁and B₁at T₁decrased in comparison with T₀.Comparedwith T₁, MAP and HR in each group increased from T₂except group A₁(P＜0.05).Moreover, MAP in group B₃was significantly higher thanthat in group A₃at T₂,T₃and T₄(P＜0.05).2Changes in the stress levelCompared with T₁,adrenaline concentration in group A₃and B₂increased from T₂(P＜0.05),but angiotensin â…¡ from T₃. Furthermore,both adrenaline and angiotensinâ…¡ in group B₃increased from T₂to T₄(P＜0.05or P＜0.01).Angiotensin â…¡ at T₂,T₃and T₄were higher ingroup B₃than those in group A₃(P＜0.05).3The dosage of propofolThe propofol dosage were4.0mg/kg,2.6mg/kg and2.0mg/kg,respectively BIS value were40,50and60.4Glucose of all group were no significant difference.Conclusions:Compared with endotracheal intubation, SLIPA^TMlaryngeal maskplacement caused less hemodynamic fluctuationand lighter stressresponse. BIS value reached50is the appropriate depth of anesthesia inSLIPA^TM laryngeal mask airway placement. Combined with midazolam,sufentanil induction of anesthesia,2.6mg/kg of propofol can inhibite ofhemodynamic fluctuations and stress response caused by laryngeal maskairway than others.It also can avoid the anesthesia overdose.