LARYNGEAL MASK I-GEL OF SECOND GENERATION AND ENDOTRACHEAL TUBE IN PROVIDING ANESTHESIA FOR THE PATIENTS WITH BREAST CANCER AND A HIGH RISK OF CARDIOVASCULAR COMPLICATIONS

Background. Cardiovascular complications are the most frequent type of life threatening complications for the surgical group of patients and it is also the main reason of increasing the length of stay at the hospital.

The most dangerous complications for the patients with concomitant cardiovascular system diseases through anesthesia may occur at the induction stage and during the management of the upper airway.

One of the recommendations in improving the safety of anesthesia is the usage of the laryngeal mask (LMA) I-GEL, which helps avoiding the development of hemodynamic responses associated with laryngoscopy and intubation.

Objectives. Comparing the clinical efficacy and safety of the LMA I-GEL of the second generation and the endotracheal tube during total intravenous anesthesia with mechanical ventilation mode PCV in patients with high risk of cardiovascular complications operated on for breast cancer.

Materials and methods. The study is conducted at the Department of Anesthesiology and Intensive Care Center of Reconstructive and Restorative Medicine (UniversityHospital) theOdessaNationalMedicalUniversity from 2011 to 2013. After the approval of the local ethics committee and signed informed consent, 96 women aged 52–76 years with moderate or high risk of cardiovascular complications — class 3 and 4 on Lee’s Revised Cardiac Risk Index which undergoes a variety of surgical interventions for the breast cancer treatment-were recruited.

Patients (ASA III) were divided into two groups depending on the method of maintaining the upper airway: group 1 — endotracheal tube (ETT) (n=48), group 2 — LMA I-GEL, the second generation (n=48). The systemic hemodynamic parameters (SBP, DBP, MBP, HR) are recorded prior to the anesthesia after the induction and immediately after the managing of the upper airway prior the surgery. In addition, we assessed the volume fraction and leak traces, the blood trace in the mouth (or ETT/LMA) after extubation and the presence of the discomfort or throat pain.

Results. Intubation associated with significantly higher increase in heart rate (HR), cardiac index (CI) and total peripheral vascular resistance (TPR). Use of LMA showed significantly fewer complaints of discomfort in the throat and requires significantly less time. Leakage rates were not significantly different in both groups.

Conclusions:

1. Tracheal intubation is related to a more pronounced hemodynamic response than installing the LMA I-gel.

2. The LMA and ETT are equally safe to establish the airway.

3. Tracheal intubation involves more frequent complaints from the oropharynx damage than laryngeal mask I-gel.

Given these results, we recommend LMA I-gel, second generations as a tool for securing the upper airway during the anesthetic management of surgical interventions of breast cancer patients with a high risk of cardiovascular complications.