A comparison of laryngeal mask airway-supreme and endotracheal tube use with respect to airway protection in patients undergoing septoplasty: a randomized, single-blind, controlled clinical trial

Abstract

Background There are doubts among anesthesiologists on the use of the Laryngeal Mask Airway (LMA) in nasal surgeries because of concerns about the occurrence of blood leakages to the airway. We hypothesized that the use of LMA-Supreme (LMA-S) in nasal surgery is comparable with endotracheal tube (ETT) according to airway protection against blood leakage through the fiberoptic bronchoscopy, oropharyngeal leakage pressure (OLP), heart rate (HR), mean arterial pressure (MAP), and postoperative adverse events. Methods The present study was conducted in a prospective, randomized, single-blind, controlled manner on 80 patients, who underwent septoplasty procedures under general anesthesia, after dividing them randomly into two groups according to the device used (LMA-S or ETT). The presence of blood in the airway (glottis/trachea, distal trachea) was analyzed with the fiberoptic bronchoscope and a four-point scale. Both groups were evaluated for OLP; HR; MAP; postoperative sore throat, nausea, and vomiting; dysphagia; and dysphonia. Results In the fiberoptic evaluation of the airway postoperatively, less blood leakage was detected in both anatomic areas in the LMA-S group than in the ETT group (glottis/trachea, p = 0.004; distal trachea, p = 0.034). Sore throat was detected less frequently in the LMA-S group at a significant level in the 2nd, 6th, and 12th hours of postoperative period; however, other adverse events were similar in both groups. Hemodynamic parameters were not different between the two groups. Conclusion The present findings demonstrate that the LMA-S provided more effective airway protection than the ETT in preventing blood leakage in the septoplasty procedures. We believe that the LMA-S can be used safely and as an alternative to the ETT in septoplasty cases. Trial registration This trial is registered at the US National Institutes of Health (ClinicalTrials.gov) # NCT03903679 on April 5, 2019.

The effectiveness of the Ambu® AuraGain™ laryngeal mask on hemodynamic and respiratory parameters in patients undergoing septoplasty: A randomized prospective clinical study

“…Studies on Ambu® AuraGain™ LMA generally found that it was similar or superior to ETT in terms of hemodynamic data [5,12,15]. The analysis of heart rates in our study showed higher values in the ETT group at intubation.…”

“…The groups had similar characteristics in terms of demographic data (Table 1). The insertion times were 13 (5) seconds in the LMA group and 50 (15) seconds in the ETT group. Three patients in the ETT group developed nausea, and 1 patient in the LMA group developed a cough.…”

“…This result can be considered an indication that LMA provides sealing even at higher pressures. Karaaslan et al [5] compared the LMA Supreme and ETT in patients undergoing septoplasty and found that LMA provided more protection in preventing blood leak. Al-Mazrou et al [6] concluded that LMA may be preferred as an alternative to ETT for pediatric patients undergoing sinusoidal surgery.…”

Efficacy of Laryngeal Mask Airway Compared to Endotracheal Tube: A Randomized Clinical Trial

“…This study was performed on 80 patients undergoing thoracic and abdominal surgery under general anesthesia who were referred to Hazrat Fatemeh Hospital affiliated to Iran University of Medical Sciences in Tehran during March 2020-September 2020 (Figure 1). The sample size was calculated to be 40 for each group using a web-based formula considering α = 0.05, 1-β = 0.9, and effect size = 0.71 (12). The inclusion criteria were ASA 1 or 2 based on the physical status classification system and being in the age range of 25 -60 years.…”

“…The advantages of LMA compared to tracheal intubation are no tracheal injury during tube installation and removal, less airway stimulation, less invasion of the airway tissue, easier installation, and efficient establishment (6)(7)(8)(9). Therefore, in adults, it is recommended to use LMA as a substitute for tracheal intubation, especially in patients with a history of intubation, the possibility of difficult intubation diagnosed by an anesthesiologist, and patients whose intubation has failed and venti-lation can be performed with a mask (10)(11)(12). Some studies reported hemodynamic alterations and recovery time in the LMA group during general anesthesia were similar to those in the tracheal intubation group (13)(14)(15).…”