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A comparison between laryngeal mask airway and the laryngeal tube suction during spontaneous ventilation

Clinical Research 7 min 200

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Created On: 07/02/2020

A comparison between laryngeal mask airway and the laryngeal tube suction during spontaneous ventilation

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Key take away

The results of the study conclude that both LMA and LTS-D are suitable and useful for airway treatment in patients breathing spontaneously during general anaesthesia for minor surgery of short duration.

Background

The laryngeal mask airway LMA and laryngealube suction-disposable (LTS-D) is the second generation single-use supraglottic airway devices (SADs) with gastric access that are used for management of airway during general anaesthesia in spontaneously and mechanically ventilated patients. A comparison has been made between LMA and Proseal laryngeal mask airway (PLMA) and the LTS-II during mechanical and spontaneous ventilation. In recent studies, the LTS-D has been compared with LMA when used by essential life support trained nurses and during pressure controlled mechanical ventilation.
The LMA and the LTS-D were compared with respect to oxygenation saturation (SpO₂) and end-tidal CO2(ETCO₂), time to achieve an adequate airway, ease of insertion, need for interventions to optimise ventilation, cuff-leak pressure, ventilatory variables, fiberoptic score, and adverse perioperative events.

Rationale behind research:

The data comparing LMA with the LTS-D during spontaneous ventilation was not available. The hypothesis was that despite differences in their structural design, the LMA and LTS-D have similar performances in patients breathing spontaneously during general anaesthesia.

Objective:

This randomized study was aimed to compare the LMA and the LTS-D with respect to oxygenation saturation (SpO₂) and end-tidal CO₂(ETCO₂), time to achieve an adequate airway, ease of insertion, need for interventions to optimize ventilation, cuff-leak pressure, ventilatory variables, fiberoptic score, and adverse perioperative events.

Method

Study outcomes:

Patient demographic and clinical characteristics were studied at baseline
The primary concerns evaluated were oxygenation and adequacy of ventilation
Secondary outcomes were time to achieve an adequate airway, ease of insertion, airway intervention requirements, cuff seal leak pressure, respiratory variables, fiberoptic view, the success of gastric drain insertion, and perioperative airway-related adverse events

Time Points: NA

Result

Outcomes

Baseline: There were no significant differences observed at baseline

Study outcomes:

There were no cases of desaturation of oxygen saturation (SpO₂) values of less than 95% occurred with either device.
The mean difference for SpO₂ found no clinically significant differences between the two devices (0.7%) (Fig 2)

There were incidences of slight hypercapnia to acceptable values during spontaneous ventilation.

Conclusion

The results of the study indicated that LMA and the LTS-D are equally useful for airway management, in patients breathing spontaneously during general anaesthesia of short duration. There were statistically significant differences observed in the SpO₂, but not clinically significant. The ETCO₂ concentrations were not differentiated. The minimal hypercapnia lies within the acceptable values that occurred with both SADs during natural ventilation. No statistical differences observed between the two groups regarding the inspiratory and expiratory minute volume. Also, no differences observed in the complication rate between both the groups in the incidence of device blood staining, sore throat, and hoarseness, suggesting that both SADs are similar regarding airway trauma. The techniques for insertion of both the LTS-D and LMA were observed to be different but straightforward. It was found that in LTS-D group more jaw thrust maneuvers was necessitated to achieve an adequate airway. There are structural and anatomical differences in the designs, but the ventilatory performances of both devices were similar.

Limitations

There can be a risk of bias in this study due to the absence of blinding
The results of this study couldnot be applied to patients who are mechanically ventilated
Both devices were used for short anaesthetics only

Clinical take-away

The LMA and the LTS-D devices are useful in airway management of spontaneously breathing patients undergoing general anaesthesia for a short duration of minor elective surgery with a low rate of complications.