Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trial
Abstract Background The obstetric airway is a significant cause of maternal morbidity and mortality. Endotracheal intubation is considered the standard of care but the laryngeal mask airway (LMA) has gained acceptance as a rescue airway and has been incorporated into the obstetric airway management...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-07-01
|
| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12871-019-0792-9 |
| _version_ | 1818245459524714496 |
|---|---|
| author | Wei Yu Yao Shi Yang Li Yong Jin Yuan Hon Sen Tan Nian-Lin R. Han Rehena Sultana Pryseley N. Assam Alex Tiong-Heng Sia Ban Leong Sng |
| author_facet | Wei Yu Yao Shi Yang Li Yong Jin Yuan Hon Sen Tan Nian-Lin R. Han Rehena Sultana Pryseley N. Assam Alex Tiong-Heng Sia Ban Leong Sng |
| author_sort | Wei Yu Yao |
| collection | DOAJ |
| description | Abstract Background The obstetric airway is a significant cause of maternal morbidity and mortality. Endotracheal intubation is considered the standard of care but the laryngeal mask airway (LMA) has gained acceptance as a rescue airway and has been incorporated into the obstetric airway management guidelines. In this randomized controlled equivalence trial, we compared the Supreme LMA (SLMA) with endotracheal intubation (ETT) in managing the obstetric airway during cesarean section. Methods Parturients who underwent elective cesarean section under general anesthesia were randomized to receive either an SLMA or ETT as their airway device. Our primary outcome was first-attempt insertion success. Successful insertion was defined as adequate bilateral air entry with auscultation and the presence of end-tidal carbon dioxide on the capnogram. The first-attempt insertion success rate was compared using the Chi-Square test. Secondary outcomes included time-to-ventilation, seal pressure, ventilation/hemodynamic parameters, occurrence of clinical aspiration, fetal outcomes, and maternal side effects associated with the airway device. Results We recruited 920 parturients (460 SLMA, 460 ETT) who underwent elective cesarean section under general anesthesia. Patient characteristics were similar between the groups. First attempt success was similar (Odds Ratio--ORSLMA/ETT: 1.00 (95%CI: 0.25, 4.02), p = 1.0000). SLMA was associated with reduced time to effective ventilation (Mean Difference--MD -22.96; 95%CI: − 23.71, − 22.21 s) compared to ETT group (p < 0.0001). Ventilation parameters, maternal and fetal outcomes were similar between the groups, and there was no aspiration. Conclusions SLMA could be an alternative airway management technique for a carefully selected low-risk obstetric population, with similar insertion success rates, reduced time to ventilation and less hemodynamic changes compared with ETT. Our findings are consistent with the airway guidelines in recommending the second-line use of LMA in the management of the obstetric airway. Trial registration The study was registered at http://www.clinicaltrials.gov, identifier: NCT01858467, retrospectively registered. Date of registration: May 21, 2013. |
| first_indexed | 2024-12-12T14:33:15Z |
| format | Article |
| id | doaj.art-bcf4d50a90814446946f634d6a083269 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-12T14:33:15Z |
| publishDate | 2019-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-bcf4d50a90814446946f634d6a0832692022-12-22T00:21:26ZengBMCBMC Anesthesiology1471-22532019-07-011911810.1186/s12871-019-0792-9Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trialWei Yu Yao0Shi Yang Li1Yong Jin Yuan2Hon Sen Tan3Nian-Lin R. Han4Rehena Sultana5Pryseley N. Assam6Alex Tiong-Heng Sia7Ban Leong Sng8Department of Anesthesiology and Perioperative Medicine, Quanzhou Macare Women’s HospitalDepartment of Anesthesiology and Perioperative Medicine, Quanzhou Macare Women’s HospitalDepartment of Anesthesiology, Qinghai University Affiliated HospitalDepartment of Women’s Anaesthesia, KK Women’s and Children’s HospitalDivision of Clinical Support Services, KK Women’s and Children’s HospitalCenter for Quantitative Medicine, Duke-NUS Medical SchoolSingapore Clinical Research InstituteDepartment of Women’s Anaesthesia, KK Women’s and Children’s HospitalDepartment of Women’s Anaesthesia, KK Women’s and Children’s HospitalAbstract Background The obstetric airway is a significant cause of maternal morbidity and mortality. Endotracheal intubation is considered the standard of care but the laryngeal mask airway (LMA) has gained acceptance as a rescue airway and has been incorporated into the obstetric airway management guidelines. In this randomized controlled equivalence trial, we compared the Supreme LMA (SLMA) with endotracheal intubation (ETT) in managing the obstetric airway during cesarean section. Methods Parturients who underwent elective cesarean section under general anesthesia were randomized to receive either an SLMA or ETT as their airway device. Our primary outcome was first-attempt insertion success. Successful insertion was defined as adequate bilateral air entry with auscultation and the presence of end-tidal carbon dioxide on the capnogram. The first-attempt insertion success rate was compared using the Chi-Square test. Secondary outcomes included time-to-ventilation, seal pressure, ventilation/hemodynamic parameters, occurrence of clinical aspiration, fetal outcomes, and maternal side effects associated with the airway device. Results We recruited 920 parturients (460 SLMA, 460 ETT) who underwent elective cesarean section under general anesthesia. Patient characteristics were similar between the groups. First attempt success was similar (Odds Ratio--ORSLMA/ETT: 1.00 (95%CI: 0.25, 4.02), p = 1.0000). SLMA was associated with reduced time to effective ventilation (Mean Difference--MD -22.96; 95%CI: − 23.71, − 22.21 s) compared to ETT group (p < 0.0001). Ventilation parameters, maternal and fetal outcomes were similar between the groups, and there was no aspiration. Conclusions SLMA could be an alternative airway management technique for a carefully selected low-risk obstetric population, with similar insertion success rates, reduced time to ventilation and less hemodynamic changes compared with ETT. Our findings are consistent with the airway guidelines in recommending the second-line use of LMA in the management of the obstetric airway. Trial registration The study was registered at http://www.clinicaltrials.gov, identifier: NCT01858467, retrospectively registered. Date of registration: May 21, 2013.http://link.springer.com/article/10.1186/s12871-019-0792-9Laryngeal mask airwayObstetricCesarean sectionGeneral anesthesia |
| spellingShingle | Wei Yu Yao Shi Yang Li Yong Jin Yuan Hon Sen Tan Nian-Lin R. Han Rehena Sultana Pryseley N. Assam Alex Tiong-Heng Sia Ban Leong Sng Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trial BMC Anesthesiology Laryngeal mask airway Obstetric Cesarean section General anesthesia |
| title | Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trial |
| title_full | Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trial |
| title_fullStr | Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trial |
| title_full_unstemmed | Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trial |
| title_short | Comparison of Supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section: a randomized controlled trial |
| title_sort | comparison of supreme laryngeal mask airway versus endotracheal intubation for airway management during general anesthesia for cesarean section a randomized controlled trial |
| topic | Laryngeal mask airway Obstetric Cesarean section General anesthesia |
| url | http://link.springer.com/article/10.1186/s12871-019-0792-9 |
| work_keys_str_mv | AT weiyuyao comparisonofsupremelaryngealmaskairwayversusendotrachealintubationforairwaymanagementduringgeneralanesthesiaforcesareansectionarandomizedcontrolledtrial AT shiyangli comparisonofsupremelaryngealmaskairwayversusendotrachealintubationforairwaymanagementduringgeneralanesthesiaforcesareansectionarandomizedcontrolledtrial AT yongjinyuan comparisonofsupremelaryngealmaskairwayversusendotrachealintubationforairwaymanagementduringgeneralanesthesiaforcesareansectionarandomizedcontrolledtrial AT honsentan comparisonofsupremelaryngealmaskairwayversusendotrachealintubationforairwaymanagementduringgeneralanesthesiaforcesareansectionarandomizedcontrolledtrial AT nianlinrhan comparisonofsupremelaryngealmaskairwayversusendotrachealintubationforairwaymanagementduringgeneralanesthesiaforcesareansectionarandomizedcontrolledtrial AT rehenasultana comparisonofsupremelaryngealmaskairwayversusendotrachealintubationforairwaymanagementduringgeneralanesthesiaforcesareansectionarandomizedcontrolledtrial AT pryseleynassam comparisonofsupremelaryngealmaskairwayversusendotrachealintubationforairwaymanagementduringgeneralanesthesiaforcesareansectionarandomizedcontrolledtrial AT alextionghengsia comparisonofsupremelaryngealmaskairwayversusendotrachealintubationforairwaymanagementduringgeneralanesthesiaforcesareansectionarandomizedcontrolledtrial AT banleongsng comparisonofsupremelaryngealmaskairwayversusendotrachealintubationforairwaymanagementduringgeneralanesthesiaforcesareansectionarandomizedcontrolledtrial |