Comparison of laryngeal mask airway supreme™ versus endotracheal intubation in positive pressure ventilation with muscle relaxant for intraoperative and postoperative conditions

Abstract

Background: Laryngeal Mask Airways are increasingly being used now a day as an option to endotracheal intubation, as it is less invasive and causes less discomfort in the postoperative period. The aim of this study was to evaluate the clinical use of the laryngeal mask airway SupremeTM in patients undergoing elective gynaecological surgeries under general anaesthesia and compare it with endotracheal intubation.Methods: 60 ASA I and II females, having BMI <30kg.m-2 in the range of 20-50 years of age, scheduled for elective gynaecological surgeries were randomly allocated to one of the two groups according to the device used (LMAS or ETT). Time required for insertion, number of attempts, hemodynamic response to insertion/removal and incidence of immediate and late postoperative complications such as coughing, laryngospasm, sore throat, dysphagia etc. were assessed.Results: Number of attempts for successful insertion was similar but time required for LMA Supreme™ insertion was significantly less (25.40±12.90 versus 33.27±14.82 sec) similarly, time required for nasogastric tube insertion was significantly more in ETT group (30.28±16.22 versus 21.93±12.64 sec). No episode of failed ventilation or hypoxia was recorded. The changes in hemodynamic parameters were significantly higher after endotracheal intubation and during extubation. Incidence of postoperative complications was significantly higher after endotracheal intubation (p<0.05).Conclusions: The LMA Supreme™ is a suitable alternative to endotracheal intubation during general anaesthesia for elective gynaecological surgeries with the added advantage of less hemodynamic response during airway management and lower incidence of postoperative complications.

Laryngeal mask airway supreme versus endotracheal tube for elective breast surgeries under general anaesthesia-a randomised comparative study

“…The response produced by laryngoscopy with ETT insertion was significantly greater than that caused by LMAS insertion. Findings of our study were consistent with study conducted by Singham et al [1] who reported that haemodynamic variables at baseline and before insertion were nearly similar in both the groups, however post insertion significantly increased values in HR and mean blood pressure was observed in the ETT group as compared to the LMA group. Similarly significant increase in haemodynamic variables was seen at extubation also.…”

“…In our study, the mean time required for the insertion of ETT was 26.20±2.33 sec which was significantly more compared to time required for LMA supreme insertion which was 21.00±3.20 sec (p = 0.002). Similar findings were seen in the study done by Singham et al [1] and Mahmood HE et al [17] Haemodynamic changes Our study demonstrated that there was a haemodynamic response consisting of an increase in HR and MAP associated with laryngoscopy and ETT and LMAS during, insertion as well as extubation. The response produced by laryngoscopy with ETT insertion was significantly greater than that caused by LMAS insertion.…”

“…OPEN EPI software was used for calculating the sample size. By putting the means and standard deviations for two groups as per the previous study [1] the sample size obtained is 30 for each sample, i.e. sample 1 (n=30) and sample 2 (n=30) with a confidence interval of 95% and 80% power of the study.…”

“…Over decades, endotracheal intubation has been the mainstay of airway management that has been routinely used for maintaining an open airway and allowing unobstructed breathing. However, use of ETT is associated with certain risks of laryngotracheal injury as this part of airway gets directly stimulated by this device [1,2,3,4] . The Laryngeal mask airway designed by Dr. Archie J.…”