الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
No problem is more frustrating than the anaesthetic management of a patient appearing to be normal at clinical examination but subsequently present an extremely difficult or even impossible airway to intubate thus the anaesthetist should be prepared for impending difficulty at all times which enable the operator calmly to make a rational plan of action with correct equipment immediately available. The laryngeal mask airway and the esophageal tracheal combitube are very helpful and life saving equipment for patients who are anaesthetized and paralysed while their lungs can not be ventilated by mask and trachea cannot be intubated.
The present study was designed to compare between endotracheal tube, laryngeal mask airway and esophageal tracheal combitube during induction, maintenance and recovery from general anaesthesia as regards ease of insertion and the time taken to insert the airway device, efficacy of oxygenation and ventilation, hemodynamic and hormonal stress responses and the complications of each method.
The work was carried out in Menoufiya university hospital on ninety adults (ASA I,II) patients scheduled for intermediate surgical procedures. They were randomly categorized into three equal groups, the first group were managed with endotracheal tube, the second group with laryngeal mask airway and the third group with esophageal tracheal combitube.
All patients received glycopyrrolate 0.4mg and medazolam 5mg intramuscularly half an hour preoperatively. Anaesthesia was induced by I.V. thiopentone sodium -5mg/kg body weight and a shot dose of succinylcholine 1 mg/kg body weight and when it weaned off, pipecuronium O.Img per kg body weight was initially given i.v followed by incremental doses according to the need.
The results of this study showed that, the three groups were not differing as regard their score of airway difficulty. And although difficulty with ETT intubation occurred in 5 cases out of 30 and with LMA difficulty occurred in 2 cases out of 30 and with ETC difficulty occurred in one case out of 30, there was no statistically significant I- difference.
The mean times spent for correct placement of the ETT, LMA and ETC were 33.0 ± 5.017, 30.3 ± 5.4 and 24.66 ± 3.92 respectively, with a significant association between the type of airway device used and the time spent for correct placement.
The heart rate showed a significant increase following induction of anaesthesia in the three groups which could be attributed to baroreceptor reflex tachycardia due to reduced peripheral vascular resistance caused by general Anaesthesia. Again, just after insertion of trior airway devices the heart rate increased significantly and this was more in patients using ETT and least ill those using LMA, and remained as such throughout the operation and also at removal of the airway device.
The mean arterial blood pressure showed a significant decrease following induction of anaesthasia in the three groups which can be attributed to decrease in total peripheral resistance caused by general anaesthesia. But just after insertion of the airway devices the mean arterial blood pressure increased significantly and become highest in patients receiving ETC and lowest in those receiving LMA, later on the mean arterial blood pressure significantly decreased gradually in the three groups^ with highest decrease in patients receiving LMA and least in ETC. At extraction of the airway device the mean arterial blood pressure increased significantly more with ETC than ETT group.
The mean arterial oxygen saturation remained adequate in all airway devices. The increase in mean arterial oxygen saturation, was significantly highest in ETC and significantly least in LMA group from 5 minutes after insertion till the end of the operation.
But immediately before extraction of the airway devices the mean arterial oxygen saturation was significantly higher in ETT group than in LMA and ETC groups.
The end tidal carbon dioxide decreased significantly in the three groups after insertion of the airway devices and starting controlled ventilation with significant higher decrease in patients receiving ETT than those receiving either LMA or ETC.
The mean serum Cortisol level increased significantly in the three groups, 30 minutes after insertion from 17.1 ± 7.8 to 25.25 ± 12.22 ug/dl in group I (ETT), from 16.75 ± 8.34 to 19.24 ± 7.46LMA 16 ug/dl to 32.12 ± 9.63 ug/dl in group III (ETC), with highest changes occurred with ETC and lowest changes occurred with LMA.
^ The mean recovery times were 12.5 ± 2.26, 8.82 ± 1.41 and 11.37 ± 2.47 minutes in group 1, II and III respectively. The LMA had significantly shorter mean recovery time than both ETT and ETC group.
-Arrhythmia, cough at extubation, Hoarseness of voice, sore throat and post-operative shivering occurred significantly more in patients receiving ETT.
- Displacement of the airway device and leakage of gases around the airway device occurred more in patients receiving LMA.
- Readjustment of the airway device and partial airway obstruction due to laryngeal spasm intraoperatively, tinge of blood on the device at removal and post operative nausea occurred more, with LMA and ETC than with ETT.