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Laryngeal masks as airway management in major urological surgery – a safe alternative?

Authors

Roiss M. et al.

Publication

Abstract and poster presentation at the Anesthesiology 2011 Annual Meeting [Abstract A1059], 15-19 October 2011, Chicago, IL, USA.

Summary

  • To compare the rate of complications with the LMA Supreme™ and an endotracheal tube in patients undergoing major urological surgery involving spinal anaesthesia
  • Use of the LMA Supreme™ versus an endotracheal tube was associated with a significantly reduced incidence of coughing during surgery, and coughing and choking during extubation
  • Use of the LMA Supreme™ versus an endotracheal tube was associated with a significantly reduced incidence of coughing during surgery, and coughing and choking during extubation

Objectives:

  • To compare the rate of complications with the LMA Supreme™ and an endotracheal tube in patients undergoing major urological surgery involving spinal anaesthesia

Method:

  • This was a prospective study in which patients undergoing retropubic radical prostatectomy were randomised to receive either the LMA Supreme™ or an endotracheal tube
  • The main outcome of interest during the study was the occurrence of adverse events
    • Specific events of interest included aspiration, coughing or choking during surgery and extubation, post-operative nausea or vomiting and post-operative sore throat
  • Post-operative lung function, quantified by spirometry and pulse oximetry, was also assessed

Results:

  • Patients received the LMA Supreme™ (n=50) or an endotracheal tube (n=50)
    • The mean age and body mass index of included patients was 66 years and 26.9 kg/m2, respectively
  • Adverse events that occurred in LMA Supreme™ and endotracheal tube recipients are shown in Figure 1
    • There were no incidences of aspiration in either treatment group
    • The incidence of coughing during surgery and coughing and choking during extubation was significantly lower in patients who received the LMA Supreme™ versus the endotracheal tube
Figure 1. Adverse events in patients who received the LMA Supreme™ and an endotracheal tube

  • Peripheral oxygen saturation in LMA Supreme™ recipients was significantly higher than that in endotracheal tube recipients after 1 hour in the post-anaesthesia care unit and 24 hours after surgery (Figure 2)
  • Although lung function (i.e. vital capacity, forced vital capacity, forced expiratory volume in 1 second and peak expiratory flow rate) was significantly impaired in both groups of patients in the first 24 hours post-surgery, impairment was less in recipients of the LMA Supreme™
Figure 2. Percentage change from baseline (pre-operative period) in peripheral oxygen saturation (SpO2) in patients who received the LMA Supreme™ and an endotracheal tube (data shown as mean ± standard deviation)

Conclusions:

  • Compared with an endotracheal tube, the LMA Supreme™ was associated with a significantly reduced incidence of coughing during surgery and coughing and choking during extubation in patients undergoing major urological surgery
  • The LMA Supreme™ appears to offer advantages over an endotracheal tube in terms of post-operative pulse oximetry and lung function
  • The results of this study suggest that the LMA Supreme™ is “a valuable alternative” to the endotracheal tube in patients undergoing major urological surgery