The use of supraglottic airway vs tracheal tube for endoscopic nasal sinus surgery

Abstract

BackgroundThe purpose of this study is to find whether supraglottic devices (SGD) have some advantages over tracheal intubation for a group of patients undergoing nasal sinus surgery. Since its invention, the supraglottic airway has revolutionized anesthetic practice. It is being used extensively for patients’ airway management and can have a positive effect on induction time, and patients’ airway stimulation, both at induction and during emergence from anesthesia. MethodsWith Institutional Review Board approval, 98 patients were enrolled in the study, excluding those with a history of prior gastric surgery, history of aspiration pneumonia, gastroparesis, patient-stated history of gastroesophageal reflux when lying supine, or a given history of hiatal hernia. Patients received either an endotracheal tube or a supraglottic airway for airway management during their sinus procedures. All patients were maintained with general anesthesia. Study designNon-randomized, prospective. ResultsNo Patients exhibited clinical signs of aspiration. There were no instances of oxygen desaturation. All patients were discharged home as planned and there were no hospital admissions. ConclusionsAdvantages of the SGD are that it is easy to insert, and does not require muscle relaxants or laryngoscopy for placement. Hemodynamic and stress responses associated with both laryngoscopy and tracheal intubation are avoided. Environmental inhalational gas exposure is comparable to the use of an endotracheal tube. There is also lower reported incidence of coughing, laryngospasm and breath holding. In the SGD, anesthetic requirement for tolerating the airway is less than with an endotracheal tube. An endotracheal tube in the airway at the time of emergence is a stimulus for coughing, which can provoke nasal bleeding, and which is important to avoid in sinonasal operations. In this sample of data, there was no difference in airway irritation between the two methods of maintaining the airway. The use of a supraglottic airway or laryngeal mask airway device was comparable in maintaining the airway during sinus surgeries in this sample of data. There were no differences in outcomes for the variables studied.