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Sparing the larynx during gynecological laparoscopy: a randomized trial comparing the LMA Supreme™ and the ETT

Authors

Abdi W. et al.

Publication

Acta Anaesthesiol Scand 2010; 54 (2): 141-146.

Summary

  • A study to compare the performance of the LMA Supreme™ and an endotracheal tube in patients undergoing elective gynaecological pelvic laparoscopy requiring anaesthesia
  • The average time to airway placement and weaning was shorter in patients who received the LMA Supreme™ versus the endotracheal tube
  • The LMA Supreme™ was associated with less post-operative pharyngolaryngeal morbidity than an endotracheal tube in patients undergoing routine gynaecological laparoscopic procedures

Objectives:

  • To compare the performance of the LMA Supreme™ and an endotracheal tube in patients undergoing elective gynaecological pelvic laparoscopy requiring anaesthesia

Method:

  • This was a prospective, randomised, single-blind study undertaken in American Society of Anesthesiologists class 1 or 2 adult female patients with normal airways
  • Patients were randomised to receive airway management with either the LMA Supreme™ or an endotracheal tube
  • Outcomes of interest were
    • Pharyngolaryngeal discomfort in the post-operative period
    • Ventilation efficiency
  • The difficulty of airway management was assessed using a visual analogue scale (VAS) ranging from 0 (no difficulty) to 100 (impossible)
  • The intensity of pharyngolaryngeal symptoms was measured using a numerical rating scale (NRS) ranging from 0 (no discomfort/pain) to 100 (extreme discomfort/ maximal imaginable pain)
  • All surgical procedures were performed by a single surgeon who was blinded to the airway management technique used

Results:

  • Patients were randomised to receive the LMA Supreme™ (n=69) or an endotracheal tube (n=69)
    • The demographic characteristics of the two groups of patients were similar (mean age 33 years; mean body weight 66 kg)
  • Ventilation was successful in all patients, regardless of whether they received the LMA Supreme™ or an endotracheal tube
  • The maximum peak airway pressure during anaesthesia was 25 and 23 cm H2O in patients fitted with the LMA Supreme™ and an endotracheal tube, respectively
  • The average time to airway placement and weaning was shorter in patients who received the LMA Supreme™ versus an endotracheal tube (Figure 1)
Figure 1. Duration of airway placement and weaning in patients who received the LMA Supreme™ and an endotracheal tube (data are shown as mean ± standard deviation)

† Time from injection of atracurium to definitive ventilation through the airway; ‡ Time from the last trocar to airway removal
  • The median VAS score for airway management difficulty was 5 (range 0-25) in the LMA Supreme™ group and 5 (range 0-40) in the endotracheal tube group
  • The incidences of nausea and vomiting and the need for analgesia in the post-operative period were similar in both patient groups
  • The incidences of dysphagia, hoarseness and sore throat were significantly (p<0.05) lower in patients who received the LMA Supreme™ versus an endotracheal tube (Table 1)

 

  • Assessments in the post-anaesthesia care unit showed that patients who received the LMA Supreme™ versus the endotracheal tube reported a significantly (p<0.05) lower intensity of dysphagia (mean NRS score 7 vs. 15) and hoarseness (mean NRS score 3 vs. 19)
  • In the ward prior to discharge, the intensity of hoarseness remained significantly lower in patients who received the LMA Supreme™ versus the endotracheal tube (mean NRS score 1 vs. 10; p<0.05)
  • Two patients in the endotracheal tube group complained of hoarseness at an evaluation visit at day 5-7 (compared with no patients treated with the LMA Supreme™)

Conclusions:

  • The LMA Supreme™ and an endotracheal tube were similarly effective ventilation devices in patients undergoing routine gynaecological laparoscopic procedures
  • The incidence and intensity of post-operative pharyngolaryngeal morbidity was reduced in patients who received the LMA Supreme™ versus an endotracheal tube