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Research Article
Hemodynamic response, coughing and the 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
Ricard Valero
Hospital Clinic of Barcelona
Corresponding Author
License:
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Background:
We aimed to compare systemic and cerebral hemodynamic variables and cough incidence during emergence from general anesthesia after pituitary surgery in patients after extubation of an endotracheal tube (ETT) or after replacing the ETT with a laryngeal mask airway (LMA).
Methods:
Patients undergoing pituitary surgery were randomized (open-label parallel trial) to awaken with the ETT in place or after it had been replaced with a LMA before extubation. We recorded mean arterial pressure (MAP), heart rate, middle cerebral artery (MCA) flow velocity, regional cerebral oxygen saturation (SrO2), cardiac index, norepinephrine plasma concentrations, need for vasoactive drugs, coughing during emergence, and incidence of postoperative cerebrospinal fluid (CSF) leakage.
Results:
Forty-five patients were included. MAP was lower during emergence than at baseline in both groups. More patients required antihypertensive drugs in the ETT group (34.8% vs 14.3%; P = 0.17). MCA flow velocity was higher in the ETT group (e.g., mean [95% confidence interval] 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 plasma levels were similar. Coughing was more frequent in the ETT group (15% vs 81%; P < 0.001). CSF leakage occurred in 3 patients (13%) in the ETT group only.
Conclusions:
Placing a LMA before removing an ETT during emergence from anesthesia after pituitary surgery favors a safer cerebral hemodynamic profile and reduced coughing. This strategy may also lower the risk for CSF leakage.
Trial registration number:
NCT02988804 (clinicaltrials.org) (09/12/2016).
Keywords
Laryngeal mask airway, neuroanesthesia, awakening, cerebral hemodynamic response, systemic hemodynamic response, cerebrospinal fluid leakage
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CURRENT STATUS: Under Review
Version 1
Posted 18 Feb, 2021
No community comments so far
Reviewer #1 agreed
On 28 Feb, 2021
Reviewers invited
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On 18 Feb, 2021
Editor invited
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On 17 Feb, 2021
First submitted
On 04 Feb, 2021
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Subject Areas
Anesthesiology & Pain Medicine
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This preprint is under consideration at BMC Anesthesiology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Hemodynamic response, coughing and the 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
Ricard Valero
Hospital Clinic of Barcelona
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 18 Feb, 2021
No community comments so far
Reviewer #1 agreed
On 28 Feb, 2021
Reviewers invited
Invitations sent on 18 Feb, 2021
Editor assigned
On 18 Feb, 2021
Editor invited
On 18 Feb, 2021
Submission checks complete
On 17 Feb, 2021
First submitted
On 04 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Anesthesiology & Pain Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background:
We aimed to compare systemic and cerebral hemodynamic variables and cough incidence during emergence from general anesthesia after pituitary surgery in patients after extubation of an endotracheal tube (ETT) or after replacing the ETT with a laryngeal mask airway (LMA).
Methods:
Patients undergoing pituitary surgery were randomized (open-label parallel trial) to awaken with the ETT in place or after it had been replaced with a LMA before extubation. We recorded mean arterial pressure (MAP), heart rate, middle cerebral artery (MCA) flow velocity, regional cerebral oxygen saturation (SrO2), cardiac index, norepinephrine plasma concentrations, need for vasoactive drugs, coughing during emergence, and incidence of postoperative cerebrospinal fluid (CSF) leakage.
Results:
Forty-five patients were included. MAP was lower during emergence than at baseline in both groups. More patients required antihypertensive drugs in the ETT group (34.8% vs 14.3%; P = 0.17). MCA flow velocity was higher in the ETT group (e.g., mean [95% confidence interval] 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 plasma levels were similar. Coughing was more frequent in the ETT group (15% vs 81%; P < 0.001). CSF leakage occurred in 3 patients (13%) in the ETT group only.
Conclusions:
Placing a LMA before removing an ETT during emergence from anesthesia after pituitary surgery favors a safer cerebral hemodynamic profile and reduced coughing. This strategy may also lower the risk for CSF leakage.
Trial registration number:
NCT02988804 (clinicaltrials.org) (09/12/2016).
Figure 1
Figure 2
Figure 3