Cardiovascular changes after extraglottic airway insertion:: A prospective, randomized comparison between the laryngeal mask or the new PAXpress

Study Objective: To compare hemodynamic responses induced with the new extraglottic airway, PA(Xpress), and the classic Laryngeal Mask Airway (LMA). Design: Prospective, randomized study. Setting: Anesthesia department of a university teaching hospital. Patients: 70 ASA physical status I and II patients, aged 18 to 65 years, scheduled to receive general anesthesia for extraabdominal procedures of short duration. Interventions: Patients were randomly allocated to receive either a LAM (n = 35) or a PA(Xpress) (n = 35) placement. After midazolam premedication (0.05 mg kg-1) and general anesthesia induction (propofol 2.5 mg kg-1, and fentanyl 1 mug kg-1) the airways were placed according to manufacturer instructions; then general anesthesia was maintained with a 2% sevoflurane concentration and an air/oxygen mixture. Measurements and Main Results: Arterial blood pressure [both systolic (SBP) and diastolic (DBP)] and heart rate (HR) values were recorded immediately before airway placement, immediately after airway placement, then every 1 minute during the first 5 minutes. During the first 5 minutes after airway insertion, both SBP and DBP values were higher with the PA(Xpress) than the LMA (repeated measures analysis of variance:p = 0.02 and p = 0.006, respectively), whereas no differences were reported in HR values. Also, the maximum percentage increase in both SBP and DBP values was larger with PAXpress [+ 19% (range: - 19% to + 80%) for SBP and + 26 % (range: - 17 % to + 96 %) for DBP] than the LMA [+ 9 % (range: - 30% to + 90%) for SBP and + 10% (range: - 30 % to + 92 %) for DBP] (p = 0.006 and p = 0.001, respectively). Conclusions: Although further studies are required to evaluate safety and airway trauma of this new extraglottic airway, placing the PA(Xpress) produces more marked changes in [GRAPHICS] hemodynamic variables as compared with those produced by the LMA. (C) 2004 by Elsevier Inc.