Laryngeal Mask Airway Group Research Articles

Laryngeal mask airway or high flow nasal cannulaversusnasal cannula for advanced bronchoscopy – a randomized controlled trial

Research QuestionAdvanced bronchoscopic procedures became a widely prevalent evaluation and treatment modality. These procedures require appropriate sedation and respiratory support. This study directly compares three respiratory support methods during advanced bronchoscopy.MethodsThis 3-arm, prospective, block randomized trial included 60 consenting adult patients that were referred for advanced bronchoscopy involving endobronchial ultrasound with transbronchial needle aspiration (EBUS – TBNA) and met inclusion / exclusion criteria. Patients were randomized to undergo a bronchoscopy through a laryngeal mask airway (LMA), or with a high-flow nasal cannula (HFNC) or low flow nasal cannula (NC), with bronchoscopy performed through a bite block. Demographic, procedural and clinical parameters were compared between the 3 groups, including complications, oxygenation, ventilation and need for intervention.ResultsAnalysis according to intention to treat was made for the 20 patients in each arm. There were no significant differences in demographic parameters, pre-morbidities, and procedure type and duration between groups. Hypoxia was significantly more common in the NC group (90%) compared with the LMA (45%) and HFNC (26%) groups (p<0.01). Need for interventions and their number was also lower in the LMA (40%) and HFNC (52.6%) groups compared to the NC group (90%, p< 0.01). A multivariate analysis confirmed both HFNC and LMA as independent predictors of lower rate of recurrent desaturation events and fewer complications in general compared to NC.

Perbedaan Tingkat Nyeri Tenggorokan Pasca Ekstubasi Endotracheal Tube (ETT) dan Laryngeal Mask Airway (LMA) di RSUD Dr. Soedirman Kebumen

General anesthesia is a condition in which the patient loses consciousness completely after taking certain medications. Sore throat is a common complication in postoperative patients with general anesthesia after extubation with laryngeal mask airway or endotracheal tube. The aim of this study was to compare the level of throat pain after extubation using an endotracheal tube versus a laryngeal mask airway. Methods: A quantitative cross-sectional approach was utilized, with accidental sampling as the technique. The study sample comprised 78 respondents who underwent surgery and were extubated with either an endotracheal tube or a laryngeal mask airway at Dr. Soedirman Hospital, Kebumen. Data analysis was conducted using the Mann-Whitney test. Results: Each group, consisting of endotracheal tube and laryngeal mask airway users, had 39 respondents. Throat pain was reported by 34 respondents (84.6%) in the endotracheal tube group and 27 respondents (69.2%) in the laryngeal mask airway group. The Mann-Whitney test yielded a p-value of 0.022, which is less than 0.05. Conclusion: There is a significant difference in the level of sore throat in postoperative patients with the laryngeal extubation technique with the laryngeal mask air way extubation technique and the endotracheal tube extubation technique at dr. Soedirman Kebumen Hospital.

Laryngeal mask airway versus endotracheal tube during percutaneous dilatational tracheostomy in critically ill adult patients

BackgroundOne of the most often used bedside surgical techniques in critical care units (ICUs) for critically ill individuals who need prolonged mechanical ventilation is percutaneous dilatational tracheostomy (PDT). Numerous difficulties may arise from puncturing the esophagus or making a false passage during surgery.ObjectivesTo compare the use of laryngeal mask airway (LMA) and endotracheal tube (ETT) during PDT guided by ultrasonography (US) or bronchoscopy.MethodsOur study was a prospective cohort of 120 patients admitted to the Critical Care Department at Kasr Alainy Hospital and Damanhur Medical National Institute between March 2020 and November 2021. Hemodynamics, arterial blood gasses, complications, and outcomes of the patients were recorded.ResultsThe studied patients were divided into the ETT and LMA groups (60 patients in each group). Then, each group was subdivided into two subgroups (ETT-US, ETT-Bronch, LMA-US, and LMA-Bronch; 30 patients in each subgroup) according to the guiding procedure used for puncturing the trachea: US-guided or bronchoscopy-guided. Regarding HR, there was no statistically significant difference between the two groups or four subgroups before, during, and after the procedure. In addition, there was no statistically significant difference between the two studied groups regarding MAP before the procedure. However, during and after the procedure, MAP was significantly higher in the ETT group. There was no discernible change in oxygen saturation or PaO2 before, during, or after the procedure. However, there was no discernible difference in PaCO2 levels before and after the procedure; it was much greater in the ETT group and ETT-Bronch subgroup during the process. Furthermore, there was no statistically significant variation in the number of punctures between the two groups or the four subgroups. The length of the process varied significantly across the two major groups and the four evaluated subgroups. The LMA group had the shortest procedure duration (5.05 ± 1.28 min), the LMA-Bronch subgroup (4.79 ± 1.42 min), and the LMA-US subgroup (5.31 ± 1.10 min), while the ETT had the longest procedure duration group (5.86 ± 1.11 min), the ETT-Bronch subgroup (6.09 ± 1.23 min), and ETT-US (5.63 ± 0.94 min). Regarding complications, there was no considerable difference between the two groups or four subgroups except aerophagia. Aerophagia was considerably more common in the LMA group (7 candidates) and was not observed in the ETT group.ConclusionsOur study concluded that the laryngeal mask airway improves ventilation during percutaneous dilatation tracheostomy, especially when used with ultrasound, and thus can be used for candidates with traumatic brain injury and brain edema.

Application of combined anesthesia with spontaneous breathing in the surgery of intertrochanteric fracture of femur in elderly patients.

This study aims to investigate the feasibility and safety of combined anesthesia with spontaneous breathing in the operation of intertrochanteric fracture of femur in the elderly. Between January 2020 and January 2023, a total of 141 elderly patients (45 males, 96 females; mean age: 72.5±6.8 years; range, 65 to 87 years) who underwent proximal femoral nail anti-rotation (PFNA) surgery for intertrochanteric fracture of femur were included in this single-blind, prospective, randomized-controlled study. The patients were randomly divided into three groups. Group A (experimental group) was a general anesthesia with laryngeal mask airway (LMA) group preserving spontaneous breathing, Group B (control group 1) was a general anesthesia with LMA group for mechanical ventilation, and Group C (control group 2) was a tracheal intubation anesthesia group for mechanical ventilation. The differences of related indexes among the three groups were compared. The mean onset time of anesthesia (6.23±1.45 vs. 12.78±2.78 vs. 13.73±2.43 min), postoperative recovery time of consciousness (8.13±0.83 vs. 11.34±0.89 vs. 12.45±0.86 min), and postoperative complete awakening time (10.45±2.34 vs. 18.87±2.56 vs. 19.62±2.93 min) were significantly shorter in Group A than in Groups B and C (p<0.05). The duration of analgesic effect was longer in Group A than in Groups B and C (p<0.05). After anesthesia, the Ramsay Sedation Scale and Visual Analog Scale (VAS) scores were significantly lower in Group A than the other groups (p<0.05). The mean Mini-Mental State Examination (MMS) scores were significantly higher in Group A than in Groups B and C (p<0.05). Hemodynamic parameters showed that blood pressure, heart rate, cardiac output, and cardiac index (CI) levels were significantly higher in Group A than the other groups (p<0.05). Our study results indicate that combined anesthesia preserving spontaneous breathing is safe and feasible in the operation of intertrochanteric fracture of femur in the elderly, with faster anesthesia recovery than the mechanical ventilation group.

Comparison of Incidence of Laryngospasm between Laryngeal Mask Airway and Endotracheal Tube during the Recovery Phase following Urological Procedure in Paediatric Patients

Airway-related issues pose significant perioperative complications in paediatric anaesthesia, with laryngospasm being particularly noteworthy. The choice of airway device has been identified as a contributing factor to this concern. This research was conducted from January to December of 2023; it specifically investigated and compared the incidence of laryngospasm following removal of a laryngeal mask airway (LMA) versus an endotracheal tube (ET) in paediatric patients undergoing elective urological procedure. Sixty ASA – I/II patients, aged 2 to 5 years and of both genders, were randomly allocated into two groups: Group I received ETT, while Group II received LMA. Various parameters including hemodynamic measures and the occurrence of laryngospasm, cough, and other complications were assessed. Results demonstrated a higher incidence of laryngospasm and cough in the ET group compared to the LMA group (p&lt;0.05). However, no significant differences were observed between the groups regarding other complications such as bradycardia, apnoea, desaturation, shivering, and abdominal distension. Adoption of a laryngeal mask airway (LMA) instead of an endotracheal tube (ET) during elective urological procedures in paediatric patients may lead to a lower occurrence of laryngospasm. CBMJ 2024 July: vol. 13 no. 02 P: 183-191

Airway management may influence postoperative ventilation need in preterm infantsafter laser eye treatment.

Retinopathy of prematurity is treated with laser photocoagulation under general anaesthesia with intubation using endotracheal tube (ETT), which carries a risk for postoperative mechanical ventilation (MV). Laryngeal mask airway (LMA) may provide a safe alternative. We assessed the need for postoperative MV in preterm infants who received LMA versus ETT. In this single-centre, retrospective cohort study, preterm infants who underwent laser photocoagulation between 2014-2021 were enroled. For airway management, patients received either LMA (n = 224) or ETT (n = 47). The outcome was the rate of postoperative MV. Patients' age were 37 [35;39] weeks of postmenstrual age, median bodyweight of Group LMA was higher than Group ETT's (2110 [1800;2780] g versus 1350 [1230;1610] g, respectively, p < 0.0001). After laser photocoagulation, 8% of Group LMA and 74% of Group ETT left the operating theatre requiring MV. Multiple logistic regression revealed that the use of LMA and every 100 g increase in bodyweight significantly decreased the odds of mechanical ventilation (OR 0.21 [95% CI 0.07-0.60], and 0.73 [95% CI 0.63-0.84], respectively). Propensity score matching confirmed that LMA decreased the odds of postoperative MV (OR 0.30 [95% CI 0.11-0.70]). The use of LMA is associated with a reduced need for postoperative MV. Using laryngeal mask airway instead of endotracheal tube for airway management in preterm infants undergoing general anaesthesia for laser photocoagulation for treating retinopathy of prematurity could significantly decrease the postoperative need for mechanical ventilation. According to our current understanding, this has been the largest study investigating the effect of laryngeal mask airway during general anaesthesia in preterm infants. Our study suggests that the use of laryngeal mask airway is a viable alternative to intubation in the vulnerable population of preterm infants in need of laser treatment.

Laryngeal mask airway versus endotracheal intubation as general anesthesia airway managements for atrial fibrillation catheter ablation: a comparative analysis based on propensity score matching.

The current evidence on the use of laryngeal mask airway (LMA) as an airway management technique for general anesthesia (GA) during atrial fibrillation (AF) catheter ablation (CA) is insufficient. This study aims to compare the feasibility, safety, and clinical benefits of LMA and endotracheal intubation (ETI) for airway management in AF CA. One hundred fifty-two consecutive patients with AF who underwent CA under GA were included and divided into two groups based on different airway management methods (66 in the LMA group, 86 in the ETI group). After propensity score matching, a final analysis cohort of 132 patients was obtained to compare procedural parameters, adverse events, and prognosis between the two groups. The LMA group exhibited significantly shorter total procedural time (p = 0.039), anesthesia induction time (p = 0.015), and recovery time (p = 0.006) compared to the ETI group. The mean arterial pressure (MAP) and heart rate were significantly lower in the LMA group during extubation and 1-min post-extubation (p < 0.05). Furthermore, the LMA group demonstrated lower MAP levels during intubation (p = 0.029). The incidences of intraoperative hypotension (p = 0.017) and bradycardia (p = 0.032) were significantly lower in the LMA group. The incidences of delayed recovery or delirium (p = 0.027), laryngeal or airway injury (p = 0.016), cough or bucking (p = 0.001), and sore throat (p < 0.001) were significantly lower in the LMA group. There were no statistically significant differences in catheter stability parameters and sinus rhythm maintenance rates between the two groups (p > 0.05). LMA is feasible, safe, and effective in AF CA as an optimized airway management technique for GA.

Can Laryngeal Mask Airway be the First Choice for Tracheal Stenosis Surgery? A Historical Cohort Study.

To compare the usage of laryngeal mask airway (LMA) and orotracheal intubation (OTI), which are separate airway management methods in tracheal reconstruction surgeries, in terms of perioperative management, mortality, and morbidity. Adult patients who underwent tracheal reconstruction surgery between June 2020 and June 2022 were included in the study, retrospectively. Patients with lost data or primary tracheal malignancy were excluded. Patients who underwent tracheal reconstruction were divided into two groups: LMA and OTI. Of a total of 57 included patients, the OTI and LMA groups had 30 (52.63%) and 27 patients (47.37%), respectively. The rate of intubated transfer to the intensive care unit and the length of stay in the intensive care unit were significantly higher in the OTI group (p=0. 014, p=0. 031) than those of the LMA group; further, in tracheal cultures, reproduction was also significantly higher in the OTI group (23.33%) (p=0. 007). The postoperative mortality rates were similar in both groups. Since the absence of tension in end-to-end anastomosis of the trachea is vital for successful surgery, the LMA application (which has no tracheal contact) can be considered superior to OTI. In this study, LMA was successfully applied in all patients. Considering that the aim of anesthesia management should be to provide adequate oxygenation and normocarbia with minimally invasive intervention, we suggest airway management using LMA as the first option for tracheal reconstruction surgery because of the advantages described in this study.

Laryngeal Mask Airway as an Appropriate Option in Pediatric Laparoscopic Inguinal Hernia Repair: A Systematic Review and Meta-Analysis

ObjectiveTo elucidate the safety and effectiveness of laryngeal mask airway (LMA) use in pediatric patients undergoing laparoscopic inguinal hernia repair. MethodsStudies were searched on the PubMed, EMBASE, and Cochrane Library databases. Only randomized controlled trials (RCTs) were included. Primary outcomes were major perioperative respiratory adverse events (PRAEs), namely laryngospasm, bronchospasm, desaturation, and aspiration. Secondary outcomes were minor PRAEs, anesthesia time, and recovery time. A meta-analysis was performed to calculate risk ratios (RR), weighted mean difference (WMD), and 95 % confidence intervals (CI) by using random effects models. ResultsIn total, 5 RCTs comprising 402 patients were included. Regarding major PRAEs, laryngospasm (RR: 0.43, 95 % CI: 0.12 to 1.47; p = 0.18), bronchospasm, and aspiration all demonstrated no difference between the laryngeal and endotracheal groups. Desaturation exhibited a trend, but this trend was not sufficiently supported with statistical evidence (p = 0.09). For minor PRAEs, fewer patients experienced incidence of cough after laryngeal mask use (RR: 0.27, 95 % CI: 0.11 to 0.67; p = 0.005). Other PRAE, namely hoarseness (p = 0.06), sore throat (RR: 1.88, 95 % CI: 0.76 to 4.66; p = 0.18), and stridor, did not differ between the 2 groups. Additionally, both anesthesia time (WMD: −6.88 min, 95 % CI: −11.88 to −1.89; p < 0.00001) and recovery time (WMD: −4.85 min, 95 % CI: −6.51 to −3.19; p < 0.00001) were shortened in the LMA group. ConclusionLMA used in pediatric laparoscopic inguinal hernia repair demonstrated no greater safety risks than endotracheal tube intubation did. Thus, anesthesiologists may shift from conventional endotracheal tube use to LMA use. Moreover, anesthesia and recovery times were shortened in the LMA group, which resulted in more efficient use of the operating room. Because of these benefits, LMA could be an appropriate option for pediatric patients undergoing laparoscopic inguinal hernia repair. Level of Evidence:Treatment Study, LEVEL III

Transnasal humidified rapid-insufflation ventilator exchange compared with laryngeal mask airway for endoscopic thoracic sympathectomy: a randomized controlled trial.

Transnasal humidified rapid-insufflation ventilator exchange (THRIVE) has the characteristics of operating easily and maintaining oxygenation and eliminating CO2, which makes it possible to be used in endoscopic thoracic sympathectomy (ETS). The application of THRIVE in ETS remains undefined. The purpose of this randomized controlled study is to assess the efficacy between THRIVE and laryngeal mask airway (LMA) for ETS. In total, 34 patients from May 2022 to May 2023 in Huazhong University of Science and Technology Union Shenzhen Hospital undergoing ETS were randomly divided into a THRIVE group (n = 17) and an LMA group (n = 17). A serial arterial blood gas analysis was conducted during the perioperative period. The primary outcome was the arterial partial pressure of carbon dioxide (PaCO2) during the perioperative period. The secondary outcome was arterial partial pressure of oxygen (PaO2) during the perioperative period. The mean (SD) highest PaCO2 in the THRIVE group and LMA group were 99.0 (9.0) mmHg and 51.7 (5.2) mmHg, respectively (p < 0.001). The median (inter-quartile range) time to PaCO2 ≥ 60 mmHg in the THRIVE group was 26.0 min (23.2-28.8). The mean (SD) PaO2 was 268.8 (89.0) mmHg in the THRIVE group and 209.8 (55.8) mmHg in the LMA group during surgery (p = 0.027). CO2 accumulation in the THRIVE group was higher than that of the LMA group during ETS, but THRIVE exhibited greater oxygenation capability compared to LMA. We preliminarily testified that THRIVE would be a feasible non-intubated ventilation technique during ETS under monitoring PaCO2.

Influence of endotracheal tube and laryngeal mask airway for general anesthesia on perioperative adverse events in patients undergoing laparoscopic hysterectomy: A propensity score-matched analysis.

To compare perioperative adverse events between general anesthesia with endotracheal tube (ETT) and general anesthesia with laryngeal mask airway (LMA) in patients undergoing laparoscopic hysterectomy. This was a large sample retrospective, propensity score-matched (PSM) study. We collected the data of 6739 female patients who underwent laparoscopic hysterectomy between January 2016 and June 2021 in our hospital, China. Patients were divided into two groups (ETT group and LMA group) according to different airway management modes. Data on all perioperative adverse events were collected. PSM analysis was performed to control confounding factors and differences in baseline values between the two groups. Finally, 4150 female patients were recruited after PSM. The total number of patients taking intraoperative vasoactive drugs during surgery was higher in the ETT group than in the LMA group (P = 0.04). The LMA group had a higher incidence of vomiting (51 [2.46%]) and somnolence (165 [7.95]) in the postanesthesia care unit (PACU) than the ETT group (71 [3.42%] and 102 [4.92%], respectively) (P = 0.02 and P < 0.001). Hypothermia was significantly higher in the LMA group (183 [10.36%]) than in the ETT group (173 [8.34%]) in the PACU (P = 0.03). The number of patients with sore throat was significantly higher in the ETT group (434 [20.02%]) than in the LMA group (299 [14.41%]) in the ward (P < 0.001). Other variables such as hypoxemia, moderate to severe pain, abdominal distension, diarrhea, sleep disorders, wound bleeding, and skin itch were not significantly different between the two groups (P > 0.05). The ETT group had more incidences of vomiting, sore throat, and cough complications and needed more drug treatment than the LMA group. LMA is a better airway management mode and LMA general anesthesia can be safely used in patients undergoing laparoscopic nonemergency hysterectomy.

Laryngeal Mask Airway Versus Endotracheal Intubation for Airway Management During Percutaneous Dilatational Tracheostomy

Aim: Tracheostomy is a common procedure performed surgically or percutaneously due to prolonged intubation. During the procedure, airway safety can be ensured using a laryngeal mask airway (LMA) or an endotracheal tube (ETT). The aim of this study was to investigate the complications associated with the use of LMA and ETT during the tracheostomy procedure, operative time, and changes in blood gas parameters.&#x0D; Materials and Methods: This study included patients admitted to the Intensive Care Units of Burdur State Hospital between 2019 and 2023. A total of 78 patients were divided into two groups: ETT (n=39) and LMA (n=39). Procedure-related complications, operative time, blood gas data were recorded from the patient files.&#x0D; Results: There was no statistically significant difference between the LMA and ETT groups in terms of complications. There was also no statistically significant difference in postoperative values of PaCO2 between the groups (p

Comparative evaluation of the clinical performance of supraglottic airways- Supreme laryngeal mask airway, I gel and baska mask

There are no studies comparing Supreme laryngeal mask airway (LMA), I gel and Baska mask in Indian population. A comparison of the clinical performance of Supreme LMA, I gel and Baska mask was undertaken in this randomized controlled study.The present research was undertaken in 75 patients aged 18 to 60 years who underwent elective surgery for less than 3-hour duration under general anaesthesia. The patients were randomly divided into three groups; Supreme LMA, I gel, and Baska mask. The oropharyngeal leak pressure (OLP) after 30 minutes to loss of spontaneous respiration was the primary objective, whereas the secondary objectives were attempts required for insertion of LMA, ease of gastric tube insertion, time required for gastric tube insertion and post-operative morbidity. The mean OLP of Baska mask group was (28.2 cm HO) as compared to Supreme LMA (25.3 cm HO) and I-gel (24.1 cm HO) groups (p-value = 0.0001). The mean gastric tube insertion time of Baska mask group was (20.7 s) as compared to Supreme LMA (6.7 s) and I-gel (9.6 s) groups (p-value = 0.0001). The three groups were comparable with regards to the number of attempts required, ease of gastric tube insertion and post-operative morbidity.A higher OLP was observed in Baska mass group as compared to Supreme LMA and I-gel. The three devices were similar in terms of attempts required for insertion, ease of gastric tube insertion and post-operative morbidity.

Effect of Laryngeal Mask Airway on Image Quality in Pediatric Patients Undergoing Brain Magnetic Resonance Imaging: A Randomized Controlled Trial.

Magnetic resonance imaging (MRI) is highly sensitive to motion, resulting in artifacts and lowering image quality. Laryngeal mask airway (LMA) provides numerous advantages over endotracheal tubes as it reduces laryngospasm, coughing, and the risk of postoperative desaturation. We aimed to compare LMA with oral airway for airway management during brain MRI in terms of reducing motion artifacts, which can improve image quality. This randomized, controlled, double-blind trial was carried out on 40 pediatrics aged 1 - 18 years, American Society of Anesthesiologists (ASA) physical status І and П undergoing brain MRI. Patients were randomized into two equal groups according to the airway method, the control (Guedel oral airway) group and the LMA group. A compatible anesthesia machine was used to provide O2 and sevoflurane 2% - 4%. The mean MRI image quality score was significantly higher in the LMA group than in the control group (26.10 ± 3.97 versus 18.60 ± 5.30, P < 0.001). Mean arterial blood pressure and heart rate were significantly lower in the LMA group than in the control group at all study times except at baseline and immediate post-extubation (P < 0.05). Cough was significantly lower in LMA than in the control group (15% vs. 50%, P = 0.040). Airway complications (sore throat, laryngeal spasm, and bronchospasm), nausea, and vomiting did not have a significantly different between the two groups. Compared to Guedel oral airway, using LMA for airway management in pediatrics undergoing MRI scans improved the image quality with less cough and better hemodynamics.

Comparison of oropharyngeal leak pressure of I-gelTM and BlockbusterTM laryngeal mask airway in anaesthetized pediatric patients.

Supraglottic airways (SGA) are increasingly used in pediatric anesthesia.Among SGA, I-gelTM is a commonly used device in pediatric patients. The BlockbusterTM laryngeal mask airway (LMA) is latest addition in pediatric airway armamentarium. This studywas conducted to compare the clinical performance of I-gelTM and BlockbusterTM LMA in pediatric patients. A total of 140 children aged 1-5 years, who were undergoing elective surgery,were randomized into two groups either I-gelTM (Group I) or BlockbusterTM LMA (Group B). Airway was secured with appropriate-sized LMA according to group allocation under generalanesthesia. The primary objective of study was oropharyngeal leak pressures (OPLP), andsecondary objectives were number of attempts of device insertion, success rate, ease ofLMA insertion, hemodynamic parameters, and postoperative pharyngolaryngeal morbidities. The mean OPLP was significantly higher for I-gelTM compared to BlockbusterTM LMA(27.97 ± 1.65 vs. 26.04 ± 2.12; P < 0.001). The devices were successfully inserted on thefirst attempt in 97.14% and 90% of the Group I and Group B respectively. The insertion time,ease of insertion, hemodynamic parameters and postoperative complications were comparable between groups. The I-gelTM was more efficacious device in term of OPLP than BlockbusterTMLMA for positive pressure ventilation in pediatric patients undergoing short surgical procedures under general anesthesia.

Laryngeal mask airway facilitates a safe and smooth emergence from anesthesia in patients undergoing craniotomy: a prospective randomized controlled study

BackgroundEndotracheal extubation under deep anesthesia (deep extubation) has been proved to present stable hemodynamics and steady intracranial pressure during emergence from anesthesia in patients undergoing craniotomy. This study aims to examine, in comparison with deep extubation, if a laryngeal mask airway (LMA) could provide a safer and smoother emergence from anesthesia in patients undergoing craniotomy.MethodsThis prospective randomized controlled study was conducted on patients undergoing elective craniotomy for brain tumors. After the complement of the surgical procedure, the patients had anesthesia maintained with end-tidal sevoflurane concentration 2.5% and also fully regained muscle power (Time Zero), they were randomly assigned to ETT Group (n = 29) for deep extubation or to LMA Group (n = 29), where the endotracheal tube was replaced by a laryngeal mask airway. The primary outcomes were respiratory complications, airway interventions and hemodynamic changes through emergence from anesthesia till 30 min following Time Zero. The secondary outcomes were re-operation incidence in 24 h, stay time in the intensive care unit and postoperative hospital days.ResultsAt 5 min before Time Zero either oxygen partial pressures (PaO2) or carbon dioxide partial pressures (PaCO2) between the two groups were comparable. No significant PaCO2 change was noted in both groups in 5 min after Time Zero, yet there was a remarkably lower PaO2 in ETT Group at that time point, 188.9 (± 71.1) in ETT Group vs 264.4 (± 85.4) in LMA Group. In ETT Group, coughs and snores were considerably more frequent, and thus more interventions were needed to maintain adequate respiration. From Time Zero on, blood pressures (systolic, diastolic and mean) and heart rates in ETT Group were generally higher than those in LMA Group, but the differences were insignificant at all time points except heart rate at 10 min after Time Zero. The secondary outcomes between the two groups were similar.ConclusionsCompared with deep extubation, a LMA, as a temporary airway replacement, facilitates a safer and smoother emergence from anesthesia for patients undergoing craniotomy, in terms of better oxygen saturation, fewer respiratory complications and fewer airway interventions.Trial registrationThe study was conducted after receiving approval from Institutional Review Board of Chang Gung Memorial Hospital, Linkou Branch, Taiwan (registration number 202102115A3; January 27, 2022), and the clinicaltrials.gov (NCT05253404) on 23 February 2022.

Supreme laryngeal mask airway for cesarean section under general anesthesia: a 10-year retrospective cohort study.

Previous research showed the use of supraglottic airways in obstetric anesthesia. The relevant evidence of laryngeal mask airway (LMA) on maternal and neonatal outcomes is still limited. We aimed to assess the maternal and neonatal outcomes when the LMA Supreme was used for cesarean section under general anesthesia. We included all patients who underwent general anesthesia for cesarean section between January 2010 and December 2019. Propensity score matching was used to reduce potential bias from non-random selection of airway intervention. The primary outcome was adverse maternal and neonatal outcomes defined as maternal regurgitation, aspiration, hypoxemia, and low neonatal Apgar scores. Secondary outcomes included patient admission to the intensive care unit, neonate required tracheal intubation, external cardiac massage, and admission to the neonatal intensive care unit. A total of 723 patients were included in the analysis; of whom, 221 received Supreme laryngeal mask airway (LMA group) and 502 were intubated with an endotracheal tube (ETT group). After propensity score matching, 189 patients remained in each group. No episode of regurgitation and aspiration occurred in both groups. There was no difference in the rates of Apgar score below 7 at 1 min (14.3% LMA group vs. 15.3% ETT group, OR 0.931, 95% CI 0.574 to 1.510, P = 0.772) and 5 min (3.7% vs. 4.2%, OR 0.875, 95% CI 0.324 to 2.365, P = 0.792). No difference was observed in the secondary outcomes between the two groups. The LMA Supreme was not associated with higher adverse maternal and neonatal outcomes when compared to an endotracheal tube for cesarean section under general anesthesia. It might be considered an alternative to tracheal intubation in obstetric practice.

LARYNGEAL MASK AIRWAY VERSUS ENDOTRACHEAL INTUBATION FOR ADENOIDECTOMY IN OUTPATIENT SURGERY - SINGLE CENTER EXPERIENCE.

Adenoidectomy with or without tonsillectomy remains one of the most routinely performed surgical procedures in children. The duration of the procedure is usually less than half an hour and is done in a day surgery setting. Airway management for adenoidectomy can be especially challenging as the airway is shared between the surgeon and the anesthesiologist. The gold standard for airway management is an endotracheal tube (ETT), even though there has been an increase in the use of laryngeal mask airway (LMA) over the past decade. This retrospective study investigated patient data collected over a 4-year period (2016 to 2020). Data included 210 cases in a day surgery setting. We analyzed the choice of airway device and use of neuromuscular blockers and analgesics for pain management. The use of LMA was noted in 67.62% while endotracheal intubation was performed in 32.38% of cases. LMA resulted in fewer respiratory complications compared to ETT (p=0.006). The need for neuromuscular blockers was also lower in the LMA group (p=0.01). There was no statistically significant difference in the intraoperative dose of opioid analgesia (p=0.09). Flexible LMA is a satisfactory alternative to endotracheal intubation for outpatient pediatric adenoidectomy.

Efficacy of high-flow nasal oxygenation compared with laryngeal mask airway in children undergoing ambulatory oral surgery under deep sedation: A randomized controlled non-inferiority trial.

High-flow nasal oxygenation (HFNO) has been suggested as an alternative oxygenation method during procedural sedation. This randomized, non-inferiority trial evaluated the safety and efficacy of HFNO compared with laryngeal mask airway (LMA) in pediatric ambulatory oral surgery under deep sedation. In total, 120 children aged 2-7 years (weight: 10-30 kg) were equally assigned into two groups, namely, HFNO with propofol total intravenous anesthesia infusion (HFNO-IV) or LMA with propofol total intravenous anesthesia infusion (LMA-IV). The primary objective was to monitor carbon dioxide (CO2) accumulation during perioperative surgery. Secondary objectives included monitoring transcutaneous oxygen saturation, grade exposure to the surgical field, perioperative adverse events, or other events. The predefined non-inferiority margin was 7 mmHg. During the COVID-19 pandemic, a novel WeChat applet was implemented to gather follow-up data after discharge. Non-inferiority could be declared for HFNO relative to LMA (mean difference in transcutaneous CO2 (TcCO2) = -1.4 mmHg, 95% CI: -2.9, 0.1 mmHg; P > 0.05). The pre-surgical TcCO2 of the HFNO-IV group (45.4 ± 4.5 mmHg) was similar to that of the LMA-IV group (44.0 ± 3.5 mmHg), within the clinically acceptable normal range. All the children maintained SpO2 levels of >97%. The surgical field exposure score of the HFNO group was significantly better than that of the LMA group. There was no significant difference between the two groups regarding risk or adverse events. HFNO was not inferior to LMA for maintaining oxygenation and ventilation in patients undergoing pediatric ambulatory oral surgery under deep sedation under strict isolation from the oral cavity to the upper airway.

Efficacy of laryngeal mask airway against postoperative pharyngolaryngeal complications following thyroid surgery: a systematic review and meta-analysis of randomized controlled studies

This meta-analysis aimed at investigating the effectiveness of laryngeal mask airway (LMA) against postoperative pharyngolaryngeal complications after thyroidectomy. MEDLINE, Cochrane Library, google scholar, and EMBASE databases were searched from inception through February, 2021, for randomized controlled trials (RCTs) comparing the incidence of pharyngolaryngeal complications following the use of LMA or endotracheal tube (ETT). Pooled results from seven RCTs involving 600 patients showed an association of LMA with a reduced risk of postoperative sore throat (POST) at 24 h [risk ratio (RR) 0.75, p = 0.006, four trials], but not at 1 h and 48 h after thyroidectomy. POST severity and hoarseness risk were lower in the LMA group than the ETT group at 1 h, 24 h, and 48 h (all p < 0.05). Nevertheless, hoarseness severity was lower in the LMA group only at postsurgical 48 h [standardized mean difference = − 0.35, p = 0.008, three trials]. Moreover, the risk of emergence cough was lower in patients using LMA than those receiving ETT (RR = 0.14, p = 0.002, two trials). The two groups did not differ in the severity of dysphagia at postoperative 1 h, 24 h, and 48 h. This meta-analysis showed that LMA may be associated with fewer pharyngolaryngeal complications compared to ETT without airway impacts. The limited number of included studies warrants further research to support our findings.