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CARDIOVASCULAR STABILITY DURING CAROTID ENDARTERECTOMY (CEA)

CARDENAS, R. MD; LUNN, J.K. MD; HILL, G.E. MD

doi: 10.1097/00000539-199802001-00057
Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Cardiovascular Anesthesia
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U of Nebraska Medical Center, Anesth. Dept., Omaha, NE.

Abstract S57

Introduction: The use of the laryngeal mask airway (LMA) is associated with a blunted response in arterial blood pressure and heart rate when compared to a comparable group of patients undergoing direct laryngoscopy and endotracheal intubation (ET) [1]. The high incidence of coronary artery disease (CAD) in patients requiring CEA makes intra-operative hypertensive and tachycardic episodes potentially serious since preoperative CAD increases the frequency of postoperative myocardial infarction [2]. Thus, techniques that minimize intraoperative hypertension and tachycardia may be advantageous during CEA.

Methods: After IRB approval and patient consent, 30 adult males scheduled for CEA were randomized into an LMA group or ET group (n=15, each group). Mean arterial blood pressure (MABP), heart rate (HR) end-tidal isoflurane, length of case, and episodes requiring vasopressor and or antihypertensive therapy were recorded.

Results: Patient demographics and isoflurane requirements (MAC-hours) were similar between groups. The mean number of hypertensive and tachycardia episodes and frequency of therapeutic intervention (anti-hypertensive, primarily labetolol) was significantly (p<.05) higher in the ET group when compared to the LMA group (Figure 1).

Figure 1

Figure 1

Discussion: These results demonstrate that patients managed with LMA for CEA have a lower number of intraoperative episodes of hypertension and tachycardia when compared to a comparable group managed with ET. LMA airway management may have an advantage over ET during CEA in appropriately selected patients.

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REFERENCES

1. Anaesthesia 1989;44:551-4.
2. Anesthesiology 1983;59:499-505.
© 1998 International Anesthesia Research Society