Hemodynamic and Hormonal Stress Responses to Endotracheal Tube and ProSeal Laryngeal Mask Airway \u2122 for Laparoscopic Gastric Banding.

BACKGROUND: The stress responses from tracheal intubation are potentially dangerous in patients with higher cardiovascular risk, such as obese patients. The primary outcome objective of this study was to test whether, in comparison with the endotracheal tube (ETT), the Proseal\u2122 Laryngeal Mask Airway (PLMA\u2122) (Laryngeal Mask Airway Company, Jersey, United Kingdom) reduces blood pressure and norepinephrine responses and the amounts of muscle relaxants needed in obese patients. METHODS: We assessed hemodynamic and hormonal stress responses, ventilation, and postoperative recovery in 75 morbidly obese patients randomized to receive standardized anesthesia with either an ETT or the PLMA\u2122 for laparoscopic gastric banding. RESULTS: In repeated-measures ANOVA, mean arterial blood pressure and plasma norepinephrine were significantly higher in the ETT group than in the PLMA\u2122 group. In individual pairwise comparisons, blood pressure rose higher in ETT than PLMA\u2122 patients after insertion and removal of airway devices, and after recovery. In ETT compared with PLMA\u2122 patients, plasma norepinephrine was higher after induction of carboperitoneum (mean \ub1 SD, 534 \ub1 198 and 368 \ub1 147 and pg/ml, P = 0.001), after airway device removal (578 \ub1 285 and 329 \ub1 128 pg/ml, P < 0.0001), and after recovery in postanesthesia care unit (380 \ub1 167 and 262 \ub1 95 and pg/ml, P = 0.003). Compared with use of the ETT, the PLMA\u2122 reduced cisatracurium requirement, oxygen desaturation, and time to discharge from both the postanesthesia care unit and the hospital. CONCLUSIONS: PLMA\u2122 reduces stress responses and postoperative complaints after laparoscopic gastric banding