Anesthesia for Intranasal Surgery

Webster, A. C.; Morley‐Forster, Patricia; Janzen, Victor; Watson, James T.; Dain, Steven; Taves, Donald H.; Dantzer, Dale

doi:10.1097/00000539-199902000-00037

Cited by 26 publications

(16 citation statements)

References 13 publications

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“…A lower incidence of some postoperative airway complications has been reported when using the FLMA. In addition, the FLMA has been found to have some shortcomings, such as difficulty of insertion, the possibility of dislocation during the procedure, the risk of ventilation into the esophagus and stomach, and an increased risk of aspiration and partial upper airway obstruction [ 6 , 7 ]. However, many of these studies included small numbers of subjects, and their conclusions with regard to some issues are controversial.…”

Section: Introductionmentioning

confidence: 99%

Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

Lian

2016

PLoS ONE

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ObjectiveFlexible laryngeal mask airways (FLMAs) have been widely used in thyroidectomy as well as cleft palate, nasal, upper chest, head and neck oncoplastic surgeries. This systematic review aims to compare the incidence of airway complications that occur during and after general anesthesia when using the FLMA and endotracheal intubation (ETT). We performed a quantitative meta-analysis of the results of randomized trials.MethodsA comprehensive search of the PubMed, Embase and Cochrane Library databases was conducted using the key words "flexible laryngeal mask airway" and "endotracheal intubation". Only prospective randomized controlled trials (RCTs) that compared the FLMA and ETT were included. The relative risks (RRs) and the corresponding 95% confidence intervals (95% CIs) were calculated using a quality effects model in MetaXL 1.3 software to analyze the outcome data.ResultsTen RCTs were included in this meta-analysis. There were no significant differences between the FLMA and ETT groups in the incidence of difficulty in positioning the airway [RR = 1.75, 95% CI = (0.70–4.40)]; the occurrence of sore throat at one hour and 24 hours postoperative [RR = 0.90, 95% CI = (0.13–6.18) and RR = 0.95, 95% CI = (0.81–1.13), respectively]; laryngospasms [RR = 0.58, 95% CI = (0.27–1.23)]; airway displacement [RR = 2.88, 95% CI = (0.58–14.33)]; aspiration [RR = 0.76, 95% CI = (0.06–8.88)]; or laryngotracheal soiling [RR = 0.34, 95% CI = (0.10–1.06)]. Patients treated with the FLMA had a lower incidence of hoarseness [RR = 0.31, 95% CI = (0.15–0.62)]; coughing [RR = 0.28, 95% CI = (0.15–0.51)] during recovery in the postanesthesia care unit (PACU); and oxygen desaturation [RR = 0.43, 95% CI = (0.26–0.72)] than did patients treated with ETT. However, the incidence of partial upper airway obstruction in FLMA patients was significantly greater than it was for ETT patients [RR = 4.01, 95% CI = (1.44–11.18)].ConclusionThis systematic review showed that the FLMA has some advantages over ETT because it results in a lower incidence of hoarseness, coughing and oxygen desaturation. There were no statistically significant differences in the difficulty of intubation or in the occurrence of laryngospasms, postoperative sore throat, airway displacement, aspiration or laryngotracheal soiling. However, there was a higher incidence of partial upper airway obstruction in the FLMA than in the ETT group. We conclude that the FLMA has some advantages over ETT, but surgeons and anesthesiologists should be cautious when applying the mouth gag, moving the head and neck, or performing oropharyngeal procedures to avoid partial upper airway obstruction and airway displacement. The FLMA should not be used on patients at high risk for aspiration.

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Section: Introductionmentioning

confidence: 99%

Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

Lian

2016

PLoS ONE

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“…Several studies on LMA and ETI during adenotonsillectomy and other surgical procedures reported a significant increase in the rate of laryngospasm with ETI compared with LMA 14 - 17 whereas some others failed to show any significant increase in the rate of laryngospasm with ETI. 11 We believe that the incidence of complications associated with LMA use, include breath holding, laryngospasm, bronchospasm, increased air leakage, desaturation and ETI requirement, increase when adequate anesthesia depth cannot be achieved by volatile anesthetics due to air leaks secondary to the incomplete placement of the LMA.…”

Section: Discussionmentioning

confidence: 99%

The use of flexible laryngeal mask airway for Adenoidectomies: An experience of 814 Paediatric patients

et al. 2017

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Objective:To assess flexible laryngeal mask airway (F-LMA) use during pediatric adenoidectomies in terms of patient safety, comfort, complication rates and surgeon satisfaction levels.Methods:Patients who had undergone an elective adenoidectomy after receiving general anesthesia using F-LMA from June 2012 to November 2015 were included. Patients’ demographics and the incidence of perioperative complications were investigated. The surgeon’s satisfaction level was also evaluated by questionnaire.Results:Eight hundred fourteen patient were included in the study. Conversion from F-LMA to an endotracheal tube was carried out in two patients (0.2%). Airway complications were identified in two patients. The mean duration of stay in the postoperative anesthesia care unit was 17 minutes. All patients were discharged the same day. According to the otolaryngologists F-LMA applications provide a significant reduction in the processing time (100%), postoperative patient comfort is better than when using endotracheal intubation (83.3%) and the consensus was that there should be a complete continuation of the use of the F-LMA (100%) in subsequent adenoidectomies.Conclusion:Our data show that the use of F-LMA for pediatric adenoidectomies has well tolerability profile and resulted in a lower incidence of complications. We think that the use of F-LMA for pediatric adenoidectomy is safer, simpler and speeder method.

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“…In the present study, the removal of airway devices was implemented when patients opened their eyes and responded to verbal commands. However, awake extubation is consequentially accompanied by excessive bleeding and oxyhemoglobin desaturation [8]. When compared to the ETT, the LMA does not directly stimulate the larynx.…”

Section: Discussionmentioning

confidence: 99%

“…The laryngeal mask airway (LMA) has been proved to be suitable for the intranasal surgery [8–11]. When compared with the tracheal intubation, the LMA has many advantages, such as minimal cardiovascular response, lack of tracheal stimulation, less sore throats [12].…”

Section: Introductionmentioning

confidence: 99%

Laryngeal Mask Airway Does Not Reduce Postoperative Nasal Bleeding Outside the Operation Room after Intranasal Surgery

Zhang

Feng

et al. 2013

The Scientific World Journal

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Background. The aim of this study was to detect the effect of the laryngeal mask airway (LMA) versus the endotracheal tube (ETT) on postoperative nasal bleedings in and outside the operation room (OR) after intranasal surgery. Methods. 134 patients undergoing elective intranasal surgeries were randomly allocated to receive LMA or ETT during general anesthesia. The incidence, episodes, and severity of nasal bleeding were evaluated in the OR and within the postoperative 24 hours in the ward. Furthermore, medical assistance and severe complications were assessed. Results. The overall incidence of postoperative nasal bleeding throughout the observation period was similar between the two groups. The LMA reduced nasal bleeding in the OR. However, outside the OR, the incidence of the first episode of postoperative nasal bleeding in the LMA group was higher than that in the ETT group (difference: −26.5%; 95% CI: −42.2% to −10.7%; P < 0.001). In the LMA group, more patients needed medical assistance (P = 0.029), and the number of assistance was also higher (P = 0.027) in the ward. No severe complications occurred during the observation period. Conclusion. The LMA does not alleviate nasal bleeding conditions and even increases the demands of medical service outside the OR after intranasal surgery, although it reduces epistaxis during extubation.

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Anesthesia for Intranasal Surgery

Cited by 26 publications

References 13 publications

Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

The use of flexible laryngeal mask airway for Adenoidectomies: An experience of 814 Paediatric patients

Laryngeal Mask Airway Does Not Reduce Postoperative Nasal Bleeding Outside the Operation Room after Intranasal Surgery

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