Comparative hemodynamic responses to endotracheal intubation versus laryngeal mask airway insertion in burn patients at tertiary care hospital in Peshawar

Background: Burn patients are more susceptible to hemodynamic stress due to hypermetabolism, catecholamine release, and circulatory instability. Therefore, airway management is a critical consideration for anesthesia services in the context of burn care. Endotracheal tube intubation (ETT) is the established airway management technique, but carries the highest risk of sympathetic stimulation, and therefore increased heart rate and blood pressure. Laryngeal Mask Airway (LMA) insertion is relatively less invasive, and may result in better hemodynamic stability.
Objective: This study aimed to analyze hemodynamic changes, including heart rate, blood pressure (systolic, diastolic, and mean arterial), and the occurrence of arrhythmias, following endotracheal tube (ETT) and laryngeal mask airway (LMA) insertion in burn patients receiving general anesthesia.
Materials and Methods: An observational cross-sectional study was conducted at the Burns and Plastic Surgery Unit at Lady Reading Hospital, Peshawar. This study enrolled 52 patients, aged between 18 to 60 years with burns, and classified as ASA I or II. This was done by using a non-probability, consecutive sampling technique. The patients were divided into two equal (n = 26) groups: Endotracheal Tube (ETT) and Laryngeal Mask Airway (LMA) groups. For each group, the vital parameters were recorded pre-surgery, immediately after the insertion of the airway, at 1, 3 and 5 minutes, and after the extubation process was completed. The collected data were analyzed using SPSS version 23. For data analysis, Independent Sample T Test and Fishers Exact test were done, and a p value of less than 0.05 was taken as statistically significant.
Results: In the ETT group, the hemodynamic responses seen were markedly elevated compared to the LMA group. Following the insertion of the airway, the ETT group had a significantly higher average heart rate than the LMA group (115.61 ± 6.50 vs. 98.76 ± 3.83, p < 0.001). Systolic blood pressure, diastolic blood pressure, and mean blood pressures all showed a similar pattern of increase. In the ETT group there were 4 patients (15.4%) that had arrhythmias, and there were 0 cases in the LMA group.
Conclusion: LMA insertion gives better hemodynamic stability and less cardiovascular complications than ETT intubation for select burn patients who are undergoing short procedures with general anesthesia.