Hemodynamic Response, Coughing and Incidence of Cerebrospinal Fluid Leakage on Awakening with an Endotracheal Tube or Laryngeal Mask Airway in Place after Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial
We aimed to compare systemic and cerebral hemodynamics and coughing during emergence after pituitary surgery after endotracheal tube (ETT) extubation or after replacing ETT with a laryngeal mask airway (LMA). Patients were randomized to awaken with an ETT in place or after replacing it with an LMA....
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-06-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/10/13/2874 |
| _version_ | 1797528498188845056 |
|---|---|
| author | Paola Hurtado Javier Tercero Marta Garcia-Orellana Joaquim Enseñat Luis Reyes Gemma Cabedo Jose Rios Enrique Carrero Nicolas de Riva Jaume Fontanals Isabel Gracia Isabel Belda Ana M. Lopez Neus Fabregas Ricard Valero |
| author_facet | Paola Hurtado Javier Tercero Marta Garcia-Orellana Joaquim Enseñat Luis Reyes Gemma Cabedo Jose Rios Enrique Carrero Nicolas de Riva Jaume Fontanals Isabel Gracia Isabel Belda Ana M. Lopez Neus Fabregas Ricard Valero |
| author_sort | Paola Hurtado |
| collection | DOAJ |
| description | We aimed to compare systemic and cerebral hemodynamics and coughing during emergence after pituitary surgery after endotracheal tube (ETT) extubation or after replacing ETT with a laryngeal mask airway (LMA). Patients were randomized to awaken with an ETT in place or after replacing it with an LMA. We recorded mean arterial pressure (MAP), heart rate, middle cerebral artery (MCA) flow velocity, regional cerebral oxygen saturation (SrO<sub>2</sub>), cardiac index, plasma norepinephrine, need for vasoactive drugs, coughing during emergence, and postoperative cerebrospinal fluid (CSF) leakage. The primary endpoint was postoperative MAP; secondary endpoints were SrO<sub>2</sub> and coughing incidence. Forty-five patients were included. MAP was lower during emergence than at baseline in both groups. There were no significant between-group differences in blood pressure, nor in the number of patients that required antihypertensive drugs during emergence (ETT: 8 patients (34.8%) vs. LMA: 3 patients (14.3%); <i>p</i> = 0.116). MCA flow velocity was higher in the ETT group (e.g., mean (95% CI) at 15 min, 103.2 (96.3–110.1) vs. 89.6 (82.6–96.5) cm·s<sup>−1</sup>; <i>p</i> = 0.003). SrO<sub>2</sub>, cardiac index, and norepinephrine levels were similar. Coughing was more frequent in the ETT group (81% vs. 15%; <i>p</i> < 0.001). CSF leakage occurred in three patients (13%) in the ETT group. Placing an LMA before removing an ETT during emergence after pituitary surgery favors a safer cerebral hemodynamic profile and reduces coughing. This strategy may lower the risk for CSF leakage. |
| first_indexed | 2024-03-10T10:00:11Z |
| format | Article |
| id | doaj.art-ee9409bc465747f7af5e96959021f809 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T10:00:11Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-ee9409bc465747f7af5e96959021f8092023-11-22T02:04:28ZengMDPI AGJournal of Clinical Medicine2077-03832021-06-011013287410.3390/jcm10132874Hemodynamic Response, Coughing and Incidence of Cerebrospinal Fluid Leakage on Awakening with an Endotracheal Tube or Laryngeal Mask Airway in Place after Transsphenoidal Pituitary Surgery: A Randomized Clinical TrialPaola Hurtado0Javier Tercero1Marta Garcia-Orellana2Joaquim Enseñat3Luis Reyes4Gemma Cabedo5Jose Rios6Enrique Carrero7Nicolas de Riva8Jaume Fontanals9Isabel Gracia10Isabel Belda11Ana M. Lopez12Neus Fabregas13Ricard Valero14Department of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Neurosurgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Neurosurgery, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainBiostatistics and Data Management Platform, Hospital Clínic de Barcelona, University of Barcelona, Barcelona,08036, SpainDepartment of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainDepartment of Anesthesiology, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, SpainWe aimed to compare systemic and cerebral hemodynamics and coughing during emergence after pituitary surgery after endotracheal tube (ETT) extubation or after replacing ETT with a laryngeal mask airway (LMA). Patients were randomized to awaken with an ETT in place or after replacing it with an LMA. We recorded mean arterial pressure (MAP), heart rate, middle cerebral artery (MCA) flow velocity, regional cerebral oxygen saturation (SrO<sub>2</sub>), cardiac index, plasma norepinephrine, need for vasoactive drugs, coughing during emergence, and postoperative cerebrospinal fluid (CSF) leakage. The primary endpoint was postoperative MAP; secondary endpoints were SrO<sub>2</sub> and coughing incidence. Forty-five patients were included. MAP was lower during emergence than at baseline in both groups. There were no significant between-group differences in blood pressure, nor in the number of patients that required antihypertensive drugs during emergence (ETT: 8 patients (34.8%) vs. LMA: 3 patients (14.3%); <i>p</i> = 0.116). MCA flow velocity was higher in the ETT group (e.g., mean (95% CI) at 15 min, 103.2 (96.3–110.1) vs. 89.6 (82.6–96.5) cm·s<sup>−1</sup>; <i>p</i> = 0.003). SrO<sub>2</sub>, cardiac index, and norepinephrine levels were similar. Coughing was more frequent in the ETT group (81% vs. 15%; <i>p</i> < 0.001). CSF leakage occurred in three patients (13%) in the ETT group. Placing an LMA before removing an ETT during emergence after pituitary surgery favors a safer cerebral hemodynamic profile and reduces coughing. This strategy may lower the risk for CSF leakage.https://www.mdpi.com/2077-0383/10/13/2874laryngeal mask airwayneuroanesthesiaawakeningcerebral hemodynamic responsesystemic hemodynamic responsecerebrospinal fluid leakage |
| spellingShingle | Paola Hurtado Javier Tercero Marta Garcia-Orellana Joaquim Enseñat Luis Reyes Gemma Cabedo Jose Rios Enrique Carrero Nicolas de Riva Jaume Fontanals Isabel Gracia Isabel Belda Ana M. Lopez Neus Fabregas Ricard Valero Hemodynamic Response, Coughing and Incidence of Cerebrospinal Fluid Leakage on Awakening with an Endotracheal Tube or Laryngeal Mask Airway in Place after Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial Journal of Clinical Medicine laryngeal mask airway neuroanesthesia awakening cerebral hemodynamic response systemic hemodynamic response cerebrospinal fluid leakage |
| title | Hemodynamic Response, Coughing and Incidence of Cerebrospinal Fluid Leakage on Awakening with an Endotracheal Tube or Laryngeal Mask Airway in Place after Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial |
| title_full | Hemodynamic Response, Coughing and Incidence of Cerebrospinal Fluid Leakage on Awakening with an Endotracheal Tube or Laryngeal Mask Airway in Place after Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial |
| title_fullStr | Hemodynamic Response, Coughing and Incidence of Cerebrospinal Fluid Leakage on Awakening with an Endotracheal Tube or Laryngeal Mask Airway in Place after Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial |
| title_full_unstemmed | Hemodynamic Response, Coughing and Incidence of Cerebrospinal Fluid Leakage on Awakening with an Endotracheal Tube or Laryngeal Mask Airway in Place after Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial |
| title_short | Hemodynamic Response, Coughing and Incidence of Cerebrospinal Fluid Leakage on Awakening with an Endotracheal Tube or Laryngeal Mask Airway in Place after Transsphenoidal Pituitary Surgery: A Randomized Clinical Trial |
| title_sort | hemodynamic response coughing and incidence of cerebrospinal fluid leakage on awakening with an endotracheal tube or laryngeal mask airway in place after transsphenoidal pituitary surgery a randomized clinical trial |
| topic | laryngeal mask airway neuroanesthesia awakening cerebral hemodynamic response systemic hemodynamic response cerebrospinal fluid leakage |
| url | https://www.mdpi.com/2077-0383/10/13/2874 |
| work_keys_str_mv | AT paolahurtado hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT javiertercero hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT martagarciaorellana hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT joaquimensenat hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT luisreyes hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT gemmacabedo hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT joserios hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT enriquecarrero hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT nicolasderiva hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT jaumefontanals hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT isabelgracia hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT isabelbelda hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT anamlopez hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT neusfabregas hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial AT ricardvalero hemodynamicresponsecoughingandincidenceofcerebrospinalfluidleakageonawakeningwithanendotrachealtubeorlaryngealmaskairwayinplaceaftertranssphenoidalpituitarysurgeryarandomizedclinicaltrial |