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 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--OR SLMA/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.

Second generation laryngeal mask airway during laparoscopic living liver donor hepatectomy: a randomized controlled trial

“…It demonstrated that ETT insertion is more irritating than LMA insertion and cause hemodynamic instability. This result is consistent with previous researches demonstrated that the insertion and removal of the LMA was less invasive and induces fewer stress responses than with ETT [18][19][20] . Thus, we suggested that second-generation LMA will be more suitable for patients requiring hemodynamic stability.…”

Successful use of CPAP in a pregnant patient with COVID-19 pneumonia

“…Obstetric airway management offers its own unique challenges, with failure reported to carry an incidence of 0.4% globally. 7 Moreover, preterm delivery may lead to significant complications such as neonatal ARDS, visual and hearing problems, poorer neurodevelopmental outcomes and learning difficulties in childhood. 8 In the context of our case, the team-based approach proved to be particularly helpful in aiming to limit adverse outcomes to our patient and the fetus should respiratory deterioration have occurred.…”

The role of supraglottic airway devices in obstetric anaesthesia

“…The use of SGA in emergency situations such as rescue airway device is easily justifiable as the risks of aspiration outweigh the potential of hypoxaemia and death. However, since 2001, the use of SGA as primary airway device during GA for CD has been demonstrated in several studies and been reviewed on several occasions [8][9][10][11][12][13][14][15][16][17]19,43 && ,44,45 && ,46]. To date, there are at least twelve peer reviewed studies describing the use of SGA as primary airway device (Table 1) [8][9][10][11][12][13][14][15][16][17][18][19].…”

“…However, since 2001, the use of SGA as primary airway device during GA for CD has been demonstrated in several studies and been reviewed on several occasions [8][9][10][11][12][13][14][15][16][17]19,43 && ,44,45 && ,46]. To date, there are at least twelve peer reviewed studies describing the use of SGA as primary airway device (Table 1) [8][9][10][11][12][13][14][15][16][17][18][19]. Eight articles describe the use of SGA as a primary airway device during elective CDs under GA [8,9,[11][12][13][14]18,19], three studies report the use of SGA in elective and emergency caesarean deliveries [10,16,17] and one study in emergency cases only [15].…”

“…In obstetric practice, SGA are confined to use as a rescue airway device when failed intubation occurs [1,7 & ]. More recently, SGAs have been used as the primary airway device for elective and emergency caesarean delivery (CDs) in carefully selected patient cohorts [8][9][10][11][12][13][14][15][16][17][18][19]. This review aims to discuss the place of SGAs in obstetric anaesthetic practice and review the available literature.…”