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. 2021 Jun 28;10(13):2874.
doi: 10.3390/jcm10132874.

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

Paola Hurtado  1 , Javier Tercero  1 , Marta Garcia-Orellana  1 , Joaquim Enseñat  2 , Luis Reyes  2 , Gemma Cabedo  1 , Jose Rios  3   4 , Enrique Carrero  1 , Nicolas de Riva  1 , Jaume Fontanals  1 , Isabel Gracia  1 , Isabel Belda  1 , Ana M Lopez  1 , Neus Fabregas  1 , Ricard Valero  1   4   5
Affiliations

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

Paola Hurtado et al. J Clin Med. .

Abstract

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 (SrO2), 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 SrO2 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%); p = 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-1; p = 0.003). SrO2, cardiac index, and norepinephrine levels were similar. Coughing was more frequent in the ETT group (81% vs. 15%; p < 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.

Keywords: awakening; cerebral hemodynamic response; cerebrospinal fluid leakage; laryngeal mask airway; neuroanesthesia; systemic hemodynamic response.

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Conflict of interest statement

López has received material and funding for academic or scientific purposes from Teleflex, Ambu A/S, and Bioser, and as a consultant for Ambu A/S. Valero has received consulting fees from Medtronic. The other authors declare that they have no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow diagram of patient enrolment, one loss, and data analysis.
Figure 2
Figure 2
Changes in mean arterial blood pressure (MAP) in patients in the endotracheal tube (ETT) and laryngeal mask airway (LMA) groups. (* p < 0.001 with respect to baseline; # p < 0.05 with respect to baseline). Time 0 was the end of surgery, before extubation.
Figure 3
Figure 3
Changes in peak median cerebral artery (MCA) flow velocity (cm s−1) in patients in the endotracheal tube (ETT) and laryngeal mask airway (LMA) groups. (# p < 0.05 with respect to baseline). Time 0 was the end of surgery, before extubation.
See this image and copyright information in PMC

References

    1. Lund V.J., Stammberger H., Nicolai P., Castelnuovo P., Beal T., Beham A., Carrau R. European position paper on endoscopic man-agement of tumours of the nose, paranasal sinuses and skull base. Rhinol. Suppl. 2010;22:1–143. - PubMed
    1. Ensenat J., de Notaris M., Sanchez M., Fernandez C., Ferrer E., Bernal-Sprekelsen M., Alobid I. Endoscopic endonasal surgery for skull base tumours: Technique and preliminary results in a consecutive case series report. Rhinol. J. 2013;51:37–46. doi: 10.4193/Rhino12.090. - DOI - PubMed
    1. Schubert A. Cerebral Hyperemia, Systemic Hypertension, and Perioperative Intracranial Morbidity: Is There a Smoking Gun? Anesth. Analg. 2002;94:485–487. doi: 10.1097/00000539-200203000-00002. - DOI - PubMed
    1. Bruder N.J. Awakening management after neurosurgery for intracranial tumours. Curr. Opin. Anaesthesiol. 2002;15:477–482. doi: 10.1097/00001503-200210000-00001. - DOI - PubMed
    1. Fàbregas N., Bruder N. Recovery and neurological evaluation. Best Pract. Res. Clin. Anaesthesiol. 2007;21:431–447. doi: 10.1016/j.bpa.2007.06.006. - DOI - PubMed

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