Effect Of LMA Supreme^TM And Endotracheal Intubation On Stress Response And Haemodynamics Response During Perioperative Peroid

Objective:To study the Effect of LMA SupremeTM and endotracheal intubation on stress response and haemodynamics response during perioperative peroid,to provide theoretical basis for choose right anesthesia and eliminate stress response.Method:40 ASAⅠ—Ⅱpatients aged 18-60 yr, schedule for elective surgery such as radical mastectory, Laparoscopy,hysterectomy those less than 4 hours requiring general anesthesia were recruited. They were allocated to SLMA group (n=20) and ET group(n=20). Both groups receive diazepam 10mg and Penehyclidine Hydrochloride 0.5mg before surgery.Monitor NBP,HR,Spo2 and ECG..Connect vein catheter and artery catheter. All patients received hydroxythyl starch 130/0.4 and sodium chloride solution 5 ml kg-1 over 15-30 min before induction of anaesthesia. Insert a size 3-4 LMA SupremeTM with a gastric tube(14-FG) in SLMA group after induction and also insert a size of ID7-7.5mm endotracheal tube in ET group. Fixation was by taping the tube over the chin, Once an effective airway had been obtained,turn to volume contral ventilation and monitor Etco2.A Maintenance was sevoflurane in 50% oxygen and air with remifentanyl continuous infusion.Neuromuscular blockade given intermittent,and blood product given by need. Suction was applied to the endotracheal tube and oral cavity after operation. The SLMA or endotracheal tube was removed at the end of surgery when the patient was able to open their mouth to command. To record systolic blood pressure(SBP),diastolic blood pressure (DBP),heart rate(HR) at the time of before induction(T0),immediately after the induction before intubation(T1),after intubation 1min(T2),5min(T3),3min before withdraw SLMA/endotracheal tube and 3min after it,take the patient's blood sample for measure plasma cortisol,angiotensinⅡand blood sugar. Make a survey for sore throat after surgery. Result:SLMA group.compared with T0,the SBP,DBP and HR of T1 point decreased significantly(P<0.05), the SBP,DBP,and HR of T2,T3,T4 and T5 had no significant changes, (P>0.05).ET group:compared with T0,the SBP,DBP and HR of T1 point decreased significantly(P<0.05), the SBP,DBP and HR of T2, T3,T4 and T5point increased,there was a significant difference(P<0.05);Compared the plasma cortisole and plasma angiotensinⅡconcentration in two groups:SLMA group:compare with T0,which of T1,T2,T3,T4 and T5 point had no significant difference (P>0.05).ET group:compare with T0, which of T2,T3,T4 and T5 point incresed, there was a significant difference(P<0.05), Compared with the group SLMA,the plasma cortisole and plasma angiotensinⅡconcentration of T0,T1 point had no significant changes (P>0.05), Compared with the group SLMA,the plasma cortisole and plasma angiotensinⅡconcentration of T2,T3,T4 and T5 increased, there was a significant difference(P<0.05).There were no difference between two groups for blood sugar.Sore throat:1 patient mild sore throat in SLMA group,but,7 patients mild sore throat,2 moderate and 1 severe sore throat.Conclusion:The LMA SupremeTM could effectively eliminate stress response during perioperative peroid, also help postoperative rehabilitation. The LMA SupremeTM could reduce the change of hemodynamic during perioperative peroid,also lower the cardiovascular accident.