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Wei W, Li X, Feng L, Jiao J, Li W, Cai Y, Fang R, Han Y. The effect of intraoperative transnasal humidified rapid-insufflation ventilatory exchange on emergence from general anesthesia in patients undergoing microlaryngeal surgery: a randomized controlled trial. BMC Anesthesiol 2023; 23:202. [PMID: 37312020 DOI: 10.1186/s12871-023-02169-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/08/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) has received extensive attention for its utility in tubeless anesthesia. Still, the effects of its carbon dioxide accumulation on emergence from anesthesia have not been reported. This randomized controlled trial aimed at exploring the impact of THRIVE combined with laryngeal mask (LM) on the quality of emergence in patients undergoing microlaryngeal surgery. METHODS After research ethics board approval, 40 eligible patients receiving elective microlaryngeal vocal cord polypectomy were randomly allocated 1:1 to two groups, THRIVE + LM group: intraoperative apneic oxygenation using THRIVE followed by mechanical ventilation through a laryngeal mask in the post-anesthesia care unit (PACU), or MV + ETT group: mechanically ventilated through an endotracheal tube for both intraoperative and post-anesthesia periods. The primary outcome was duration of PACU stay. Other parameters reflecting quality of emergence and carbon dioxide accumulation were also recorded. RESULTS Duration of PACU stay (22.4 ± 6.4 vs. 28.9 ± 8.8 min, p = 0.011) was shorter in the THRIVE + LM group. The incidence of cough (2/20, 10% vs. 19/20, 95%, P < 0.001) was significantly lower in the THRIVE + LM group. Peripheral arterial oxygen saturation and mean arterial pressure during intraoperative and PACU stay, Quality of Recovery Item 40 total score at one day after surgery and Voice Handicap Index-10 score at seven days after surgery were of no difference between two groups. CONCLUSIONS The THRIVE + LM strategy could accelerate emergence from anesthesia and reduce the incidence of cough without compromising oxygenation. However, these benefits did not convert to the QoR-40 and VHI-10 scores improvement. TRIAL REGISTRATION ChiCTR2000038652.
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Affiliation(s)
- Wei Wei
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Xuhui District, Shanghai, 200031, China
| | - Xiang Li
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Xuhui District, Shanghai, 200031, China
| | - Lili Feng
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Xuhui District, Shanghai, 200031, China
| | - Jiali Jiao
- Institute of Translational Medicine, Shanghai Jiao Tong University, Minhang District, Shanghai, China
| | - Wenxian Li
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Xuhui District, Shanghai, 200031, China
| | - Yirong Cai
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Xuhui District, Shanghai, 200031, China
| | - Rui Fang
- Department of Otolaryngology, Eye & ENT Hospital of Fudan University, Xuhui District, Shanghai, China
| | - Yuan Han
- Department of Anesthesiology, Eye & ENT Hospital of Fudan University, Xuhui District, Shanghai, 200031, China.
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Liu F, Xi C, Cui X, Wang G. Efficacy and Safety of Flexible Laryngeal Mask Ventilation in Otologic Surgery: A Retrospective Analysis. Healthc Policy 2022; 15:945-954. [PMID: 35585872 PMCID: PMC9109885 DOI: 10.2147/rmhp.s354891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Flexible laryngeal mask airways (FLMAs) ventilation have been widely used as airway devices during general anesthesia, especially in otologic surgery. However, the current literature reports that the clinical success and failure rates for FLMA usage are quite different, and there remains a paucity of data regarding factors associated with FLMA failure and complications related to FLMA usage. Purpose To evaluate the success and failure rates of FLMA usage in otologic surgery, the factors associated with FLMA failure and complications related to FLMA usage. Patients and Methods All patients who underwent otologic surgery, including middle ear and mastoid procedures, under general anesthesia at a large tertiary general hospital from 2015 to 2019 were reviewed. The primary outcome was the FLMA failure rate, defined as any airway event requiring device removal and tracheal intubation, including primary and secondary failure. The secondary outcomes were specific clinical factors, including patient sex, age, weight, American Society of Anesthesiologists (ASA) classification, body mass index (BMI) and duration of surgery, which were analyzed as related risk factors. Results Among 5557 patients with planned FLMA use, the final success rate was 98.5%. Sixty-seven percent of the failures occurred during initial introduction of the FLMA, 8% occurred after head and neck rotation, and 25% occurred during the procedures. Two independent clinical factors associated with FLMA failure were male sex and age. Respiratory complications were observed in 0.61% of patients, and the rate of severe nerve and tissue damage associated with FLMA use was 0.05. Conclusion This study demonstrates a high success rate of 98.5% for FLMA use in adults undergoing otologic surgery with rare adverse airway events and injuries complications. Two independent risk factors require attention and thorough and accurate management is necessary for every clinician.
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Affiliation(s)
- Feihong Liu
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Chunhua Xi
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xu Cui
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Guyan Wang, Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China, Tel +86-13910985139, Email
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The effectiveness of the Ambu® AuraGain™ laryngeal mask on hemodynamic and respiratory parameters in patients undergoing septoplasty: A randomized prospective clinical study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.951382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Farazmehr K, Aryafar M, Gholami F, Dehghanmanshadi G, Hosseini SS. A prospective study on the incidence of sore throat after use of laryngeal mask airway during general anesthesia. Ann Med Surg (Lond) 2021; 68:102595. [PMID: 34401120 PMCID: PMC8353405 DOI: 10.1016/j.amsu.2021.102595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/16/2021] [Accepted: 07/25/2021] [Indexed: 01/13/2023] Open
Abstract
Background Laryngeal mask airway (LMA) is a useful alternative to intubation of the trachea to maintain the airways. The aim of this study was to evaluate the incidence of sore throat after LMA during general anesthesia in short-duration elective surgery. Method In this prospective study, 76 patients undergoing surgery with general anesthesia in (XXX) during 2018 and 2019 were selected and their demographic information were entered into the data collection form. Laryngeal mask airway was used in the subjects for airway maintenance during the surgery. The incidence of sore throat at postoperative 0, 6, 12 h was measured using Visual Analogues Scale (VAS) as primary outcome and it was then compared with demographic parameters as secondary outcomes. Result The mean age of the patient was 45.48 ± 14.89 years and 46 (60.5 %) of the patients were women. The mean BMI was 24.02 ± 3.05 kg/m2. The average duration of surgery was 56.9 ± 15.9 min. The incidence of sore throat immediately after the surgery and at 6 and 12 postoperative hours was 26.3 %, 23.7 %, and 19.7 %, respectively. The incidence of sore throat after the use of LMA was not significantly correlated with age, sex, and BMI (P > 0.05) Conclusions The findings of our study showed that pain due to sore throat following laryngeal mask airway was reported to be mild in our study. The postoperative sore throat may not associated with demographic variables. Laryngeal mask airway is a useful alternative to intubation of the trachea to maintain the airways. Tracheal intubation is one of the invasive procedures used in patients undergoing surgery. The pain due to sore throat was reported to be mild in our study. Postoperative sore throat was not associated with demographic variables.
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Affiliation(s)
- Kourosh Farazmehr
- Department of Anaesthiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mohamad Aryafar
- Department of Anaesthiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Farshid Gholami
- Department of Anaesthiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Giti Dehghanmanshadi
- Department of Anaesthiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Seyed Sepideh Hosseini
- Student of Research Committee, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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Supraglottic airway device versus tracheal intubation and the risk of emergent postoperative intubation after general anaesthesia in adults: a retrospective cohort study. Br J Anaesth 2020; 126:738-745. [PMID: 33341223 DOI: 10.1016/j.bja.2020.10.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/20/2020] [Accepted: 10/31/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We examined the association between emergent postoperative tracheal intubation and the use of supraglottic airway devices (SGAs) vs tracheal tubes. METHODS We included data from adult noncardiac surgical cases under general anaesthesia between 2008 and 2018. We only included cases (n=59 991) in which both airways were deemed to be feasible options. Multivariable logistic regression, instrumental variable analysis, propensity matching, and mediation analysis were used. RESULTS Use of a tracheal tube was associated with a higher risk of emergent postoperative intubation (adjusted absolute risk difference [ARD]=0.80%; 95% confidence interval (CI), 0.64-0.97; P<0.001), and a higher risk of post-extubation hypoxaemia (ARD=3.9%; 95% CI, 3.4-4.4; P<0.001). The effect was modified by the use of non-depolarising neuromuscular blocking agents (NMBAs); mediation analyses revealed that 28.9% (95% CI, 14.4-43.4%; P<0.001) of the main effect was attributable to NMBA. Airway management modified the association of NMBA and risk of emergent postoperative intubation (Pinteraction=0.02). Patients managed with an SGA had higher odds of NMBA-associated reintubation compared to patients managed with a tracheal tube (adjusted odds ratio [aOR]=3.65, 95% CI, 1.99-6.67 vs aOR=1.68, 95% CI, 1.29-2.18 [P<0.001], respectively). CONCLUSIONS In patients undergoing procedures under general anaesthesia that could be managed with either SGA or tracheal tube, use of an SGA was associated with lower risk of emergent postoperative intubation. The effect can partly be explained by use of NMBAs. Use of NMBAs in patients with an SGA appears to increase the risk of emergent postoperative intubation.
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Lin GJW, Lim YC, Wang J, Shahla S. An audit of post-operative sore throat using different laryngeal mask airways. Indian J Anaesth 2020; 64:513-516. [PMID: 32792717 PMCID: PMC7398009 DOI: 10.4103/ija.ija_963_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/19/2020] [Accepted: 04/03/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- George J W Lin
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ying Ching Lim
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore
| | - Jiexun Wang
- Clinical Research Unit, Khoo Teck Puat Hospital, Singapore
| | - Siddiqui Shahla
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore
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Marinho S, Frias P, Oliveira I, Silva R, Rodrigues F, Paiva A. Subcutaneous emphysema as a complication of the use of a laryngeal mask in a child. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2020; 67:212-214. [PMID: 32178913 DOI: 10.1016/j.redar.2020.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/30/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
The use of supraglottic airway devices has been increasing in popularity, mostly due to their high success rate and low complications. However, there is very little information available about the potential and group specific concerns regarding their use in children. We present the first description of a child that developed subcutaneous emphysema after the use of a laryngeal mask. We believe that more awareness to the risk of perioperative adverse events with laryngeal mask insertion in the paediatric population is needed.
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Affiliation(s)
- S Marinho
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal.
| | - P Frias
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - I Oliveira
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - R Silva
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - F Rodrigues
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - A Paiva
- Servicio de Anestesiología, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
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Zhou GX, Rosenblatt W, Zhou SE, Dai F, Heerdt PM. Flexible laryngeal mask with pharyngeal suction for nasal surgery. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abedini N, Parish M, Farzin H, Pourfathi H, Akhsham M. The Determination of an Appropriate Time for Placement of the Classic Laryngeal Mask Airway in Patients Undergoing General Anesthesia. Anesth Pain Med 2018; 8:e64427. [PMID: 30009152 PMCID: PMC6035496 DOI: 10.5812/aapm.64427] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/12/2018] [Accepted: 04/19/2018] [Indexed: 11/29/2022] Open
Abstract
Background The management of the airways is an essential component of anesthesia planning. Laryngeal mask airway (LMA) plays an important role in modern anesthesia, however, intubation by LMA has some complications. It may cause inadequate anesthesia depth, which can lead to adverse events. The aim of this study was to evaluate the optimal time for intubation by LMA under general anesthesia. Methods This study was conducted on 96 patients, who underwent operation and were appropriate candidates for intubation with appropriate LMA. The participants were divided to four groups, each with 24 cases, based on the time interval between anesthetic agent administration and intubation with LMA; 15 seconds for the first group, 16 to 30 seconds for the second group, 31 to 45 seconds for the third group, and 45 to 60 seconds for the fourth group. The patients involved in these groups were selected based on the following prerequisites, patients’ age, gender, easy intubation, need for additional drug administration, basic blood pressure before drug administration, within the time intervals one, three, and five minutes after placement of LMA, duration of LMA, SaO2 before and after placement of LMA, coughing, patient’s movement, laryngospasm, gag reflex after intubation, allowing appropriate ventilation, presence of sore throat after surgery, number of attempts, extent of mouth opening and leak in peri-LMA space. Results Overall, 72 males and 24 females participated in this study with a mean age of 40.64. Intubation by LMA was performed easily during the first attempt in 58% of the participants, with minimal resistance in 28.6% and with some problems during the second attempt in 10.5% of the cases. Throat pain after the operation was significantly lower. Systolic and diastolic pressure and heart rate had no statistically significant difference. Conclusions The results showed that in the first 15 seconds after the drug (e.g. propofol) administration, there were lower complications, rapid placement, and optimized time for the placement of LMA. The rate of success and its quality were reduced during the first attempt of insertion and termination of the effect of propofol.
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Affiliation(s)
| | | | - Haleh Farzin
- Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hojjat Pourfathi
- Department of Anesthesiology, Taleghani Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding author: Hojjat Pourfathi, MD, Assistant Professor, Department of Anesthesiology, Taleghani Hospital, Tabriz University of Medical Sciences, Tabriz, Iran. E-mail:
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Adams AS, Wannemuehler TJ, Hull B, Wu J, Chandra RK, VonWahlde K, Shotwell MS, Harvey S, Higgins M, McQueen K, Turner JH. Randomized controlled trial comparing the supraglottic airway to use of an endotracheal tube in sinonasal surgery. Int Forum Allergy Rhinol 2018; 8:877-882. [PMID: 29719126 DOI: 10.1002/alr.22132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND The supraglottic airway (SGA) represents an alternative to endotracheal intubation (endotracheal tube [ETT]) in many types of ambulatory surgery. Adoption of the SGA has progressed slowly in sinonasal surgery due to concerns about airway protection. The purpose of this study was to compare quality of life measures and indices of airway protection between patients undergoing sinonasal surgery who were ventilated via an SGA or ETT. METHODS Patients undergoing outpatient sinonasal surgery were enrolled into a randomized, single-blind study in which patients would be ventilated with either an SGA or ETT. At the first postoperative visit, a symptom severity and quality of life questionnaire was completed. Additional objective metrics were extracted from the anesthesia record. RESULTS A total of 102 patients were enrolled; 49 assigned to the SGA group and 53 assigned to the ETT group. No significant differences in swallowing function or cough were identified. SGA patients reported more difficulty returning to a normal diet (p = 0.03) with a trend toward reduced throat pain (p = 0.07) and improved phonation (p = 0.06). No significant difference in perioperative oxygen desaturations, emesis, recovery time, or airway blood penetration were identified. CONCLUSION While the use of the SGA results in patient diet modification postoperatively, it may also be associated with a reduction in throat pain and dysphonia. SGA use had no appreciable effect on postanesthesia recovery times, oxygen desaturations, or emesis. Use of the SGA in sinonasal surgery appears to be a safe and reliable option for airway management in selected adult patients undergoing routine ambulatory sinonasal surgery.
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Affiliation(s)
- Austin S Adams
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Todd J Wannemuehler
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Benjamin Hull
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Jeffanie Wu
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Kate VonWahlde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Matthew S Shotwell
- Department of Anesthesia, Vanderbilt University School of Medicine, Nashville, TN
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Stephen Harvey
- Department of Anesthesia, Vanderbilt University School of Medicine, Nashville, TN
| | - Michael Higgins
- Department of Anesthesia, Vanderbilt University School of Medicine, Nashville, TN
| | - Kelly McQueen
- Department of Anesthesia, Vanderbilt University School of Medicine, Nashville, TN
| | - Justin H Turner
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University School of Medicine, Nashville, TN
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van Esch BF, Stegeman I, Smit AL. Comparison of laryngeal mask airway vs tracheal intubation: a systematic review on airway complications. J Clin Anesth 2016; 36:142-150. [PMID: 28183554 DOI: 10.1016/j.jclinane.2016.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 09/28/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Abstract
To determine whether the laryngeal mask airway (LMA) has advantages over the tracheal tube (TT) in terms of incidence of cough, sore throat, laryngospasm, dysphagia, dysphonia, and blood staining. This is a systematic literature review performed at the Universtity Medical Center of Utrecht. The online databases PubMed, Embase, and the Cochrane Library were searched for relevant randomized controlled trials. Two independent reviewers selected relevant articles after title, abstract, and full text screening. Articles were assessed on risk of bias in accordance with the Cochrane risk of bias tool. Study results of the LMA and the TT were related to the method of selection of the device size and the method for cuff inflation. Of the 1718 unique articles, we included 19 studies which used the LMA Classic, the LMA Proseal, the Flexible Reinforced LMA, and the LMA Supreme compared with TT. After methodological inspection, data could not be pooled due to heterogeneity among the selected studies. Overall, no clear advantage of the LMA over the TT was found but the LMA Supreme was related to the lowest incidence of airway complications. In this review, no clear difference in incidence of postoperative airway complications could be demonstrated between LMA and TT. The LMA Supreme may reduce the incidence of airway complication in comparison to the TT but high quality randomized trials are recommended to further objectify if use of the LMA decreases the risk on postoperative airway complications.
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Affiliation(s)
| | - Inge Stegeman
- Department of Otorhinolaryngology, University Medical Center Utrecht, The Netherlands and Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
| | - Adriana L Smit
- Department of Otorhinolaryngology, University Medical Center Utrecht, The Netherlands and Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
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Xu R, Lian Y, Li WX. Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes. PLoS One 2016; 11:e0158137. [PMID: 27414807 PMCID: PMC4944923 DOI: 10.1371/journal.pone.0158137] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/10/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Flexible 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. METHODS A 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. RESULTS Ten 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)]. CONCLUSION This 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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Affiliation(s)
- Rui Xu
- Department of Anesthesiology, the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai, China
| | - Ying Lian
- Department of Case Administration, Shandong Provincial Qian Foshan Hospital of Shandong University, Jinan, China
| | - Wen Xian Li
- Department of Anesthesiology, the Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai Medical College of Fudan University, Shanghai, China
- * E-mail:
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