Comparison of Oro-Pharyngeal airway cap and tracheal intubation on systemic stress responses and hemodynamic parameters in pediatric laparoscopic procedures

Objective: The adverse events caused by intubation may contribute to serious cardiovascular and systemic stress responses, especially in pediatric patients. Alternative airway maintenance techniques may attenuate these hemodynamic and systemic stress responses. This study aimed to compare the hemodynamic and systemic stress responses of the insertion of Oro-Pharyngeal airway cap (OPLAC) and Endotracheal Intubation (ETT) in pediatric laparoscopic surgery patients. Methods: Eighty-six pediatric laparoscopic surgery patients were randomly divided to receive either OPLAC (Group OPLAC) or ETT (Group ETT). Respiratory and hemodynamic parameters, inflammatory responses, oxidative stress, anesthesia recovery variables, and adverse events during emergence were compared. Results: Respiratory parameters including peak airway pressure (PAP) and end-tidal carbon dioxide pressure (PET CO2) were similar intraoperative. Heart rate and mean arterial, plasma ß-endorphin, cortisol, interleukin-6, TNF-α, malondialdehyde (MDA) levels, and blood glucose in Group OPLAC were significantly lower than those in Group ETT. Postoperative bucking, laryngospasm and serious hyoxemia were seen in Group ETT but not in Group OPLAC. Conclusion: Maintaining the airway using OPLAC is associated with less inflammatory or oxidation stress which can yield more stable hemodynamic profile compared to direct tracheal intubation.