Abstract
BackgroundNonoperating room anesthesia during gastroenterological procedures is a growing field in anesthetic practice. While the numbers of patients with severe comorbidities are rising constantly, gastrointestinal endoscopic interventions are moving closer to minimally invasive endoscopic surgery. The LMA Gastro™ is a new supraglottic airway device, developed specifically for upper gastrointestinal endoscopy and interventions. The aim of this study was to evaluate the feasibility of LMA Gastro™ in patients with ASA physical status ≥3 undergoing advanced endoscopic procedures.MethodsWe analyzed data from 214 patients retrospectively who received anesthesia for gastroenterological interventions. Inclusion criteria were upper gastrointestinal endoscopic interventions, airway management with LMA Gastro™ and ASA status ≥3. The primary outcome measure was successful use of LMA Gastro™ for airway management and endoscopic intervention.ResultsThirtyone patients with ASA physical status ≥3, undergoing complex and prolonged upper gastrointestinal endoscopic procedures were included. There were 7 endoscopic retrograde cholangiopancreatographies, 7 peroral endoscopic myotomies, 5 percutaneous endoscopic gastrostomies and 12 other complex procedures (e.g. endoscopic submucosal dissection, esophageal stent placement etc.). Of these, 27 patients were managed successfully using the LMA Gastro™. Placement of the LMA Gastro™ was reported as easy. Positive pressure ventilation was performed without difficulty. The feasibility of the LMA Gastro™ for endoscopic intervention was rated excellent by the endoscopists. In four patients, placement or ventilation with LMA Gastro™ was not possible.ConclusionsWe demonstrated the feasibility of the LMA Gastro™ during general anesthesia for advanced endoscopic procedures in high-risk patients.Trial registrationGerman Clinical Trials Register (DRKS00017396) Date of registration: 23rd May 2019, retrospectively registered.
Highlights
Nonoperating room anesthesia during gastroenterological procedures is a growing field in anesthetic practice
While the majority of gastrointestinal endoscopies are performed under conscious sedation by non-anesthesia personnel, there is a shift towards deep sedation or general anesthesia for advanced procedures and interventions [3]
Of 214 patients receiving anesthetic care in the gastroenterology suite, 75 patients were ventilated with the Laryngeal mask airway (LMA) GastroTM
Summary
Nonoperating room anesthesia during gastroenterological procedures is a growing field in anesthetic practice. While the numbers of patients with severe comorbidities are rising constantly, gastrointestinal endoscopic interventions are moving closer to minimally invasive endoscopic surgery. The LMA GastroTM is a new supraglottic airway device, developed for upper gastrointestinal endoscopy and interventions. The aim of this study was to evaluate the feasibility of LMA GastroTM in patients with ASA physical status ≥3 undergoing advanced endoscopic procedures. Nonoperating room anesthesia in the gastroenterology suite is a growing field in anesthesiology practice [1, 2]. The numbers of patients with severe comorbidities presenting for upper gastrointestinal endoscopic interventions are rising, so the need for a fast and yet gentle and safe airway device is relevant
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