ProSeal laryngeal mask airway and endotracheal tube in elderly hypertensive patients undergoing routine surgical procedures: A comparison of hemodynamic parameters

Background/PurposeThe effects of ProSeal laryngeal mask airway (PLMA) removal and tracheal extubation on cardiovascular responses were studied in elderly hypertensive patients in a randomized double-blind study.MethodsA total of 60 elderly hypertensive American Society of Anesthesiologists I–II patients were randomly allocated to two groups (n = 30 of each) for PLMA insertion or endotracheal intubation. A standardized anesthetic sequence was used for induction and maintenance of anesthesia. The two groups were then compared for pressor response at the time of extubation/PLMA removal.ResultsIn PLMA group, heart rate and rate pressure product increased during PLMA removal but remained elevated for only 3 minutes while mean arterial pressure remained elevated for only 2 minutes. The elevations of heart rate, mean arterial pressure, and rate pressure product were exaggerated in the extubation group and persisted for more than 5 minutes. No complication was observed in any patient and no difficulty was encountered in insertion of PLMA in any patient.ConclusionElderly hypertensive patients are at risk of exaggerated pressor response at the time of extubation. PLMA removal is associated with fewer hemodynamic changes than tracheal extubation and should be preferred wherever possible.