Comparison of laryngeal mask airway supreme™ versus endotracheal intubation in positive pressure ventilation with muscle relaxant for intraoperative and postoperative conditions

Authors

  • Amol Prakash Singam Department of Anaesthesiology, Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharashtra, India
  • Arpita Ashok Jaiswal Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharashtra, India
  • Ashok Ramkrishna Chaudhari Department of Anaesthesiology, Jawaharlal Nehru Medical College, Sawangi (M), Wardha, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20175538

Keywords:

Endotracheal intubation, LMA supreme™, Positive pressure ventilation

Abstract

Background: Laryngeal Mask Airways are increasingly being used now a day as an option to endotracheal intubation, as it is less invasive and causes less discomfort in the postoperative period. The aim of this study was to evaluate the clinical use of the laryngeal mask airway SupremeTM in patients undergoing elective gynaecological surgeries under general anaesthesia and compare it with endotracheal intubation.

Methods: 60 ASA I and II females, having BMI <30kg.m-2 in the range of 20-50 years of age, scheduled for elective gynaecological surgeries were randomly allocated to one of the two groups according to the device used (LMAS or ETT). Time required for insertion, number of attempts, hemodynamic response to insertion/removal and incidence of immediate and late postoperative complications such as coughing, laryngospasm, sore throat, dysphagia etc. were assessed.

Results: Number of attempts for successful insertion was similar but time required for LMA Supreme™ insertion was significantly less (25.40±12.90 versus 33.27±14.82 sec) similarly, time required for nasogastric tube insertion was significantly more in ETT group (30.28±16.22 versus 21.93±12.64 sec). No episode of failed ventilation or hypoxia was recorded. The changes in hemodynamic parameters were significantly higher after endotracheal intubation and during extubation. Incidence of postoperative complications was significantly higher after endotracheal intubation (p<0.05).

Conclusions: The LMA Supreme™ is a suitable alternative to endotracheal intubation during general anaesthesia for elective gynaecological surgeries with the added advantage of less hemodynamic response during airway management and lower incidence of postoperative complications.

References

Stauffer JL, Olson DE, Petty TL. Complications and consequences of endotraqueal intubation and tracheotomy. Am J Med. 1981;70:65-76.

Grillo HC, Donahue DM, Mathisen DJ. Postintubation tracheal stenosis. J Thorac Cardiovasc Surg. 1995;109:486-93.

Chavan SG, Mandhyan S, Gujar SH, Shinde GP. Comparison of sevoflurane and propofol for laryngeal mask airway insertion and pressor response in patients undergoing gynecological procedures. J Anaesthesiol Clin Pharmacol. 2017;33:97-101

Timmermann A, Cremer S, Eich C. Prospective clinical and fiberoptic evaluation of the Supreme laryngeal mask airway™. Anesthesiol. 2009;110:262-5.

López AM, Valero R, Hurtado P, Gambús P, Pons M, Anglada T. Comparison of the LMA Supreme™ with the LMA Proseal™ for airway management in patients anaesthetized in prone position. Brit J Anaes. 2011;107(2):265-71.

O’Connor CJ, Davies SR, Stix MS. “Soap bubbles” and “gauze thread” drain tube tests. Anesth Analg. 2001;93:1078-82.

Bein B, Scholx J. Supraglottic airway devices. Best Pract Res Clin Anaesthesiol. 2005;19(4):581-93.

Anatolij T, David Z. Ferson C. Use of the Laryngeal Mask Airway Supreme in pre-hospital difficult airway management. Resuscitation. 2008;78:107-8.

David Z, Ferson LC, Sonal Z, David B. The Effectiveness of the LMA Supreme™ in Patients with Normal and Difficult-to-Manage Airways. Anesthesiol. 2007;107:A592.

Darcy DM, Young PG. Use of the LMA-Supreme™ for Airway Rescue. Anesthesiol. 2008;109(2):356-7.

Cook TM, Woodall N, Frerk C. Major complications of airway management in the UK: results of the 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia. Br J Anaesth. 2011;106:617-31.

Barreira SR, Souza CM, Fabrizia F, Azevedo AB, Lelis TG, Lutke C. Prospective, randomized clinical trial of laryngeal mask airway Supreme (®) used in patients undergoing general anesthesia. Rev Bras Anestesiol. 2013;63:456-460

Maltby JR, Beriault MT, Watson NC, Liepert DJ, Fick GH. LMA ClassicTM and LMA-ProSealTM are effective alternatives to endotracheal intubation for gynecologic laparoscopy. Can J Anes. 2003;50:71-7.

Jones JR. Laryngeal mask airway: an alternative for the difficult airway. AANA J. 1995;63(5):444-9.

Brain AIJ, Verghese C, Strube PJ. The LMA “ProSeal”: a laryngeal mask with an oesophageal vent. Br J Anaesth. 2000;84:650-4.

Brimacombe JR, Keller C. The ProSeal laryngeal mask airway. A randomized crossover study with the standard laryngeal mask airway in paralyzed, anesthetized patients. Anesthesiol. 2000;93:104-9.

Verghese C, Ramaswamy B. LMA-Supreme-a new single-use LMA with gastric access: a report on its clinical efficacy. Br J Anaesth. 2008;101(3):405-10.

Kahla AH and Alhusaimy AM. Comparison of Laryngeal Mask Airway-Supreme and Endo- tracheal Tube in Adult Patients Undergoing Laparoscopic Surgery. Ain Shams J Anaesthesiol. 2009;2(2):73-85.

Yu SH, Beirne OR. Laryngeal mask airways have a lower risk of airway complications compared with endotracheal intubation: a systematic review. J Oral Maxillofac Surg. 2010;68:2359-76.

Zhang GH, Xue FS, Sun HY, Li CW, Sun HT, Li P, Liu KP. Comparative study of hemodynamic responses to orotracheal intubation with intubating laryngeal mask airway. Chinese Medic J. 2006;119(11):899-904.

Lim Y, Goel S, Brimacombe JR. The ProSeal laryngeal mask airway is an effective alternative to laryngoscope-guided tracheal intubation for gynaecological laparoscopy. Anaesth Intensive Care. 2007;35:52-6.

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Published

2017-12-23

How to Cite

Singam, A. P., Jaiswal, A. A., & Chaudhari, A. R. (2017). Comparison of laryngeal mask airway supreme™ versus endotracheal intubation in positive pressure ventilation with muscle relaxant for intraoperative and postoperative conditions. International Journal of Research in Medical Sciences, 6(1), 129–134. https://doi.org/10.18203/2320-6012.ijrms20175538

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Original Research Articles