Randomized controlled trial comparing the supraglottic airway to use of an endotracheal tube in sinonasal surgery

Adams, Andrew A.; Wannemuehler, Todd J.; Hull, Benjamin P.; Wu, Jeffanie; Chandra, Rakesh K.; VonWahlde, Kate; Shotwell, Matthew S.; Harvey, Stephen; Higgins, Michael S.; McQueen, Kelly; Turner, Justin H.

doi:10.1002/alr.22132

Cited by 5 publications

(2 citation statements)

References 16 publications

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“…In a number of institutions, endoscopic sinus surgery (ESS) is performed with a supraglottic airway (SGA) rather than with endotracheal intubation (ETT) although airway protection in the potentially bloody environment of sinus surgery has been a very real concern. A randomized single‐blind study in this issue of the Journal by Adams et al . demonstrates equal airway protection with SGA and ETT in sinus surgery.…”

mentioning

confidence: 93%

Additional options in chronic rhinosinusitis management

Kennedy¹

2018

Int Forum Allergy Rhinol

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mentioning

confidence: 93%

Additional options in chronic rhinosinusitis management

Kennedy¹

2018

Int Forum Allergy Rhinol

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“…Accordingly, many anaesthesiologists and otolaryngologists are reluctant to use FLMA in FESS. However, several prospective trials have indicated that FLMA effectively protects the airway from blood contamination during FESS, showing superiority in protecting the glottis and subglottic airway [5,6]. Other concerns are related to the failure rate of FLMA ventilation, which can occur because, compared with other types of LMA, the elasticity of its tube makes it more difficult to insert and align accurately.…”

Section: Introductionmentioning

confidence: 99%

Safety, efficacy and airway complications of the flexible laryngeal mask airway in functional endoscopic sinus surgery: A retrospective study of 6661 patients

Shi

Cui

et al. 2021

PLoS ONE

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Objectives Although the flexible laryngeal mask airway (FLMA) provides considerable advantages in head and neck procedures, little is known about its safety and efficacy in functional endoscopic sinus surgery (FESS). We conducted a retrospective study to evaluate the success rate of FLMA and relevant airway complications in FESS under general anaesthesia. Methods A retrospective review of consecutive patients who underwent FESS for chronic rhinosinusitis was performed from 2015 to 2019. All patients scheduled for FLMA ventilation were identified. Patient characteristics, length of the surgery, FLMA size, failed FLMA cases requiring endotracheal intubation, immediate adverse airway events and delayed airway injuries were recorded. The primary outcomes included the FLMA success rate, which was defined as primary success after induction and final success after the whole surgical procedure. The secondary outcomes were specific clinical factors associated with FLMA failure and airway complications related to FLMA usage. Results Of the 6661 patients included in our study, primary success was achieved in 6572 (98.7%), and final success was achieved in 6512 (97.8%). Failure occurred in 89 patients (1.3%) during induction, in 14 (0.2%) during surgical preparation and in 46 (0.7%) during the intraoperative procedure. All patients with failed FLMA ventilation were successfully switched to endotracheal intubation. Male sex, advanced age, higher American Society of Anesthesiologists grade (ASA) and higher body mass index (BMI) were independent risk factors associated with failed FLMA. Immediate adverse respiratory events were observed in 0.85% of the patients, and delayed airway injuries associated with use of FLMA were observed in 0.07%. Conclusion This retrospective study demonstrates a high success rate for FLMA (97.8% in 6661 patients undergoing FESS). Adverse airway events and injuries associated with FLMA are rare, but clinicians should remain vigilant so that early diagnosis and prompt treatment can be provided.

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