Sparing the larynx during gynecological laparoscopy: A randomized trial comparing the LMA Supreme™ and the ETT

Abstract

Background: We designed a prospective randomized single-blind study to compare efficiency and post-operative upper airway morbidity when the laryngeal mask airway (LMA) Supreme™ is used as an alternative to the endotracheal tube (ETT). Methods: One hundred and thirty-eight elective pelvic laparoscopic ASA I-II female patients were assigned to receive either the LMA Supreme® or the ETT for airway management. Balanced anesthesia and ventilation techniques were standardized to control end-tidal CO2 and BIS value in the range 4.5-5 kPa and 40-50, respectively, and to maintain adequate hemodynamic stability. A single surgeon blinded to the airway management technique performed all surgical procedures. The ventilation efficiency of each airway was evaluated. Anesthesia- and surgery-related times were calculated and anesthesia details were recorded. Post-operative pain and pharyngolaryngeal morbidity were measured in a blind fashion using a numerical rating scale (NRS) (0-100). Results: Surgery duration was similar in both groups. Airway management duration was shorter with the LMA Supreme ®. Post-operative pharyngolaryngeal morbidity incidence and all symptoms' intensity were significantly increased after ETT as compared with LMA Supreme® anesthesia. At the end of the PACU stage, the incidence and mean NRS of post-operative hoarseness were reduced when LMA Supreme ® was used as an alternative to the ETT (16% vs. 47%; P<0.01 and 9 vs. 19, P<0.01, respectively). Conclusion: We demonstrated that choosing an LMA Supreme® was an efficient pharyngolaryngeal morbidity-sparing strategy. Moreover, we showed that the LMA Supreme ® and the ETT were equally effective airways for a routine gynecological laparoscopy procedure. © 2009 The Acta Anaesthesiologica Scandinavica Foundation.