Hemodynamic and catecholamine stress responses to insertion of the Combitube (R), laryngeal mask airway or tracheal intubation

In a prospective, randomized, and controlled trial, we compared the stress responses after insertion of the Combitube(R) (CT; Kendall-Sheridan Cathete r Corp., Argyle, NY), the laryngeal mask airway (LMA), or endotracheal intu bation (ET). Seventy-five patients scheduled for routine urological or gyne cological surgery were randomly allocated to one of three groups and were v entilated via either an ET, a LMA, or a CT. All three devices could be inse rted easily and rapidly, providing adequate ventilation and oxygenation. In sertion of the CT was associated with a significant increase in mean maxima l systolic arterial pressure (160 +/- 32 mm Hg) and diastolic arterial pres sure (91 +/- 17 mm Hg) compared with ET (140 +/- 24, 78 +/- 11 mm Hg; P < 0 .05, P < 0.01, respectively) or insertion of the LMA (115 +/- 33, 63 +/- 22 mm Hg, both P < 0.001). The mean maximal epinephrine and norepinephrine pl asma concentrations after insertion of the CT (37.3 +/- 31.1 and 279 +/- 13 9 pg/mL, respectively) were significantly higher than those after ET (35.8 +/- 89.8 and 195 +/- 58 pg/mL, respectively) or insertion of a LMA (17.3 +/ - 13.3 and 158 +/- 67 pg/mL, respectively). This might be attributed to the pressure of the pharyngeal cuff of the CT on the anterior pharyngeal wall. We conclude that insertion of the CT causes a pronounced stress response a nd that precautions should be taken when used in patients at risk of hypert ensive bleeding. Implications: In this study, we showed that the hemodynami c and catecholamine stress responses after insertion of the Combitube(R) (K endall-Sheridan Catheter Corp., Argyle, NY) were significantly higher compa red with laryngeal mask airway or endotracheal intubation. We conclude that the increased stress response to insertion of a Combitube(R) may represent a serious hazard to patients with cardiovascular disease.