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GENERAL ARTICLES

Hemodynamic and Catecholamine Stress Responses to Insertion of the Combitube®, Laryngeal Mask Airway or Tracheal Intubation

Wolfgang Oczenski, MD^*, Herbert Krenn, MD^*, Ashraf A. Dahaba, MD, Maria Binder, MD^*, Irene El-Schahawi-Kienzl, MD^*, Helmuth Jellinek, MD^*, Sylvia Schwarz, MD^*,, and Robert D. Fitzgerald, MD^*,

*Department of Anesthesia and Intensive Care, and Ludwig Boltzmann Institute for Economics of Medicine in Anesthesia and Intensive Care, Vienna City Hospital-Lainz, Vienna, Austria

Address correspondence and reprint requests to Dr. W. Oczenski, Department of Anesthesia and Intensive Care, Vienna City Hospital Lainz, Wolkersbergenstr. 1, A-1130 Vienna, Austria. Address e-mail to ocw{at}ana.khl.magwien.gv.at

In a prospective, randomized, and controlled trial, we compared the stress responses after insertion of the Combitube® (CT; Kendall-Sheridan Catheter Corp., Argyle, NY), the laryngeal mask airway (LMA), or endotracheal intubation (ET). Seventy-five patients scheduled for routine urological or gynecological surgery were randomly allocated to one of three groups and were ventilated via either an ET, a LMA, or a CT. All three devices could be inserted easily and rapidly, providing adequate ventilation and oxygenation. Insertion of the CT was associated with a significant increase in mean maximal systolic arterial pressure (160 ± 32 mm Hg) and diastolic arterial pressure (91 ± 17 mm Hg) compared with ET (140 ± 24, 78 ± 11 mm Hg; P < 0.05, P < 0.01, respectively) or insertion of the LMA (115 ± 33, 63 ± 22 mm Hg, both P < 0.001). The mean maximal epinephrine and norepinephrine plasma concentrations after insertion of the CT (37.3 ± 31.1 and 279 ± 139 pg/mL, respectively) were significantly higher than those after ET (35.8 ± 89.8 and 195 ± 58 pg/mL, respectively) or insertion of a LMA (17.3 ± 13.3 and 158 ± 67 pg/mL, respectively). This might be attributed to the pressure of the pharyngeal cuff of the CT on the anterior pharyngeal wall. We conclude that insertion of the CT causes a pronounced stress response and that precautions should be taken when used in patients at risk of hypertensive bleeding.

Implications: In this study, we showed that the hemodynamic and catecholamine stress responses after insertion of the Combitube® (Kendall-Sheridan Catheter Corp., Argyle, NY) were significantly higher compared with laryngeal mask airway or endotracheal intubation. We conclude that the increased stress response to insertion of a Combitube® may represent a serious hazard to patients with cardiovascular disease.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999