LMA® protector™ in patients undergoing laparoscopic surgeries: a multicenter prospective observational study

BACKGROUND

Laryngeal masks airway (LMA) has been increasingly used in surgical patients. However, the use of LMA in laparoscopic surgeries remains controversial. The major concerns include the potential risk of esophageal regurgitation, aspiration, and difficulties to achieve effective ventilation. The aim of this study was to evaluate the safety and effectiveness of the LMA® Protector™ in patients undergoing laparoscopic surgery.

METHODS

Patients aged 18 to 70 years, scheduled for laparoscopic surgeries were included. The insertion time, successful insertion rate, and oropharyngeal leak pressure were measured. Airway complications and airway manipulations during the procedure were documented. Effective ventilation rate was calculated. Visible bloodstains and reflux content in the drainage channel were documented after the removal of LMA® Protector™.

RESULTS

Three hundred patients were enrolled. The insertion of LMA® Protector™ failed in seven patients resulting with a successful insertion rate of 97.7%. During the maintenance of anesthesia, airway manipulation was required in 19 patients (19/293, 6.48%), in three of whom the LMA was replaced with endotracheal intubation resulting with an effective ventilation rate of 96.7% (290/300). The oropharyngeal leak pressure was 30.18 ± 5.88 cmH2O. Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Bloodstains on study devices were noticed in 58 patients (20%). Seventy-five patients (25.86%) reported mild sore throat on the first day after surgery. Gastric reflux was noticed in the drainage tube in 5 patients (1.72%) with no signs of aspiration in any of those patients.

CONCLUSIONS

The LMA® Protector™ was shown to be safe and effective in patients undergoing laparoscopic surgeries. Although minor complications that require no further treatment, no clinically diagnosed aspiration was noticed in our study. Gastric reflux was noticed in the drainage tube in five patients undergoing laparoscopic gynecology surgery. Further research is needed to verify whether LMA® Protector™ is suitable for procedures in Trendelenburg position or other situations that a high risk of gastroesophageal reflux exists.

TRIAL REGISTRATION

The trial was registered at the Chinese Clinical Trial Registry ( ChiCTR1800018300 , date of registration: September 2018).

Comparison of early postoperative recovery between laryngeal mask airway and endotracheal tube in laparoscopic cholecystectomy: A randomized trial

BACKGROUND

Laryngeal mask airway (LMA) insertion provokes fewer stress responses than endotracheal intubation. This study aimed to evaluate the LMA Protector for assessing improvements in intraoperative hemodynamic stability and to reduce postoperative discomfort compared with endotracheal intubation in laparoscopic cholecystectomy.

METHODS

Fifty-six patients who underwent laparoscopic cholecystectomy while under sevoflurane-based general anesthesia were randomly allocated to airway management using LMA (LMA group) or endotracheal tube (ETT group). Heart rate, blood pressure, and peak airway pressure were recorded before and after carboperitoneum. Postoperative pain and analgesic requirements were assessed, in addition to nausea, hoarseness, dysphonia, and sore throat during the first 1 hour postoperatively and until postoperative day 1.

RESULTS

All patients underwent successful LMA or ETT placement within 2 attempts. There was no difference in highest mean (SD) peak airway pressure during carboperitoneum between the LMA and ETT groups (17.7 [2.8] mm Hg vs 19.1 [3.8] mm Hg, P = .159, respectively). The incidence of high systolic blood pressure and bradycardia was higher in the LMA group. The highest pain scores 1 hour postoperatively and on postoperative day 1 were lower in the LMA group than in the ETT group (3.9 [2.0] vs 5.4 [2.3], P = .017 and 5.6 [1.9] vs 6.7 [1.7], P = .042, respectively); requirements for analgesics were similar in the 2 groups. The incidence of nausea was lower in the LMA group than in the ETT group until postoperative day 1 (4/28 [14%] vs 12/28 [43%], P = .031, respectively).

CONCLUSION

The LMA Protector was an effective ventilator device associated with fewer intraoperative hemodynamic stress responses and improved the quality of early recovery after laparoscopic cholecystectomy.

Predictive risk factors of failed laryngeal mask airway insertion at first attempt

Objectives

A failed first attempt at laryngeal mask airway (LMA) insertion could increase the risk of laryngospasm, hypoxemia, and postoperative sore throat. This study was performed to investigate the risk factors for failed first-attempt LMA placement.

Methods

In total, 461 patients who underwent general anesthesia with a Supreme LMA (Teleflex Medical, Shanghai, China) and who had an American Society of Anesthesiologists (ASA) physical status of I to III were prospectively enrolled. The LMA was inserted after anesthetic induction. We recorded the insertion conditions and each patient’s age, ASA status, body weight, body mass index (BMI), duration of anesthesia, size of LMA, and cuff pressure; the years of work experience of the anesthesiologists; and the use or nonuse of lidocaine gel as a lubricant.

Results

Successful first-attempt placement of the Supreme LMA was achieved in 438 (95.10%) patients, while first-attempt placement failed in 23 (4.99%). Significant risk factors for failure of first-attempt LMA insertion included high age, high body weight, BMI of <20 kg/m², and insertion without using lidocaine gel.

Conclusions

A patient age of >61 years, high body weight, BMI of <20 kg/m², and insertion without lidocaine gel could significantly increase the risk of failed first-attempt Supreme LMA insertion.

Short-lasting pediatric laparoscopic surgery: Are muscle relaxants necessary? Endotracheal intubation vs. laryngeal mask airway

PURPOSE

Technical advances have led to lower insufflation pressures and shorter anesthesia times for children undergoing laparoscopic procedures. In this study we compared the use of endotracheal tube (ETT) and laryngeal mask airway (LMA) with or without muscle relaxant (MR) in children undergoing laparoscopic repair for inguinal hernia.

METHODS

Children undergoing laparoscopic inguinal hernia repair were randomized into four groups which underwent procedure with either ETT+MR (group 1), ETT without MR (group 2), LMA with subparalytic dose of MR (group 3) or LMA without MR (group 4). Surgical, anesthesia and recovery times, intragastric pressures and peak airway pressures during insufflation were compared.

RESULTS

After exclusion criteria and discontinued interventions, groups 1 and 3 contained 20, groups 2 and 4 contained 19 patients each. Surgical times were similar between groups. Anesthesia times were statistically significantly different between groups with shortest time in group 4 and longest time in group 1. Recovery time was statistically significantly longer in group 1 when compared to other groups. There was no difference between basal intragastric pressure, average intragastric pressure during insufflation, peak airway pressure, and average peak airway pressure during insufflation of groups.

CONCLUSION

Use of muscle relaxants in short-lasting laparoscopic procedures in children is not absolutely necessary and LMA with subparalytic dose of muscle relaxant or with no muscle relaxant is a safe alternative.

TYPE OF STUDY

Treatment study.

LEVEL OF EVIDENCE

Level II.

Supraglottic Airway Devices: the Search for the Best Insertion Technique or the Time to Change Our Point of View?

In the crowded world of supraglottic airway devices (SADs), many papers compare the easiness of insertion based on the different endpoints of an operator's satisfaction: first pass success, ventilation effectiveness, complications and morbidity. Proseal LMA^™ (Laryngeal Mask Airway, Teleflex Medical, Dublin, Ireland) has been extensively studied because on one hand it has a steeper learning curve and more complex insertion when compared with other SADs and on the other hand many alternative techniques are available to facilitate insertion. This research is part of a larger body of studies exploring the issue that some devices are more difficult to insert because of many features related to sizing, constructive material, airway conduit and cuff design, performance and last but not least experience. Nevertheless, the biggest question might be the search for a systematic categorization of insertion difficulty features and identification of criteria allowing the choice for the best device and consequently for the best insertion technique. Given that, as a result of many intrinsic characteristics of the device we are using, insertion might become the secondary issue to be considered only after we clearly identify what makes it difficult, and to be counterbalanced on the results we expect from the device, performance we can achieve and degree of airway protection it could grant. The aim of this narrative review is to consider which factors might affect or condition SAD insertion difficulty and to try identifying some criteria addressing physicians pertaining to the use of SADs in clinical practice.

Postoperative Respiratory Complications of Laryngeal Mask Airway and Tracheal Tube in Ear, Nose and Throat Operations

BACKGROUND

Supraglottic devices could be used to reduce postoperative respiratory complications, but there are few studies focused on their use in more prolonged surgeries.

OBJECTIVES

In this study, we compared postoperative respiratory complications in patients with prolonged ear, nose and throat (ENT) surgeries, whose airways were controlled with tracheal tube or laryngeal mask airway (LMA).

MATERIALS AND METHODS

In a randomized control trial (RCT), 171 candidates of prolonged ENT surgeries were randomly assigned into two groups. In group one (n = 85) LMA and in group two (n = 86) endotracheal tube were used for airway control. The incidences of four postoperative respiratory complications including sore throat, hoarseness, cough and shortness of breath in immediate postoperative period were measured and compared among patients of each group.

RESULTS

Sore throat was recorded in 32.9% of patients with LMA and 44.2% of intubated patients, but it was not statistically significant (Fisher's Exact test = 0.158). Hoarseness was recorded in 3.5% of patients with LMA and 24.4% of intubated patients (Fisher's Exact test = 0.000). In 1.2% of patients with LMA cough was recorded; it was also seen in 7% of the intubated patients (Fisher's Exact test = 0.005). Shortness of breath was mentioned by two intubated patients (2.3%) and in patient with LMA we did not record this complication.

CONCLUSIONS

LMA in prolonged ENT surgeries was associated with reduced respiratory complications.