ProSeal Laryngeal Mask Airway Attenuates Systemic and Cerebral Hemodynamic Response During Awakening of Neurosurgical Patients

Perelló-Cerdà, Laura; Fàbregas, Neus; López, Ana Marı́a; Ríos, José; Tercero, Javier; Carrero, Enrique; Hurtado, Paola; Hervías, Adriana; Caral, L.; Riva, Nicolás de; Valero, Ricard

doi:10.1097/ana.0000000000000108

Cited by 14 publications

(15 citation statements)

References 35 publications

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“…These ndings contrast with the different hemodynamic pro le of our previous study performed in patients after supratentorial craniotomy with a similar protocol. [8] In our former clinical trial on supratentorial craniotomy patients, baseline mean arterial pressure was lower than in this present study (about 20 mmHg lower). We speculate that the preoperative administration of a quite high dose of xylometazoline could provoke a similar mild hypertensive effect in all included patients.…”

Section: Discussioncontrasting

confidence: 67%

“…Our group showed that neurosurgical patients emerged from anesthesia with a more favorable hemodynamic pro le, a lower incidence of coughing and less cerebral hyperemia when a LMA was placed just after removal of the endotracheal tube (ETT) but before emergence after undergoing a supratentorial craneotomy. [8] The transnasal transsphenoidal endoscopic approach has been reported to have less associated morbidity than open surgery, [9][10] but postoperative cerebrospinal uid (CSF) leakage remains a major limitation of this technique. [11] The incidence of CSF leakage was 8% in a patient series in our hospital.…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic response, coughing and the incidence of cerebrospinal fluid leakage on awakening with an endotracheal tube or laryngeal mask airway in place after transsphenoidal pituitary surgery: a randomized clinical trial

Hurtado

Tercero

García-Orellana

et al. 2021

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Background: We aimed to compare systemic and cerebral hemodynamic variables and cough incidence during emergence from general anesthesia after pituitary surgery in patients after extubation of an endotracheal tube (ETT) or after replacing the ETT with a laryngeal mask airway (LMA). Methods: Patients undergoing pituitary surgery were randomized (open-label parallel trial) to awaken with the ETT in place or after it had been replaced with a LMA before extubation. We recorded mean arterial pressure (MAP), heart rate, middle cerebral artery (MCA) flow velocity, regional cerebral oxygen saturation (SrO2), cardiac index, norepinephrine plasma concentrations, need for vasoactive drugs, coughing during emergence, and incidence of postoperative cerebrospinal fluid (CSF) leakage. Results: Forty-five patients were included. MAP was lower during emergence than at baseline in both groups. More patients required antihypertensive drugs in the ETT group (34.8% vs 14.3%; P = 0.17). MCA flow velocity was higher in the ETT group (e.g., mean [95% confidence interval] at 15 min, 103.2 [96.3–110.1] vs 89.6 [82.6–96.5] cm s− 1; P = 0.003). SrO2, cardiac index, and norepinephrine plasma levels were similar. Coughing was more frequent in the ETT group (15% vs 81%; P < 0.001). CSF leakage occurred in 3 patients (13%) in the ETT group only. Conclusions: Placing a LMA before removing an ETT during emergence from anesthesia after pituitary surgery favors a safer cerebral hemodynamic profile and reduced coughing. This strategy may also lower the risk for CSF leakage. Trial registration number: NCT02988804 (clinicaltrials.org) (09/12/2016).

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Section: Discussioncontrasting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Hemodynamic response, coughing and the incidence of cerebrospinal fluid leakage on awakening with an endotracheal tube or laryngeal mask airway in place after transsphenoidal pituitary surgery: a randomized clinical trial

Hurtado

Tercero

García-Orellana

et al. 2021

Preprint

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“…Perell o-Cerda`et al 1 reported that before the end of neurosurgery, replacing the endotracheal tube with a LMA can avoid severe fluctuations of hemodynamic parameters during extubation. In our study, the MAP and HR in the ETI group were 5 to 6 mmHg and 11 to 15 bpm higher compared with the LMA group, respectively.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of the Ambu® AuraOnce™ laryngeal mask and endotracheal intubation in anesthesia airway management during neurosurgery

et al. 2020

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Objective: To investigate the feasibility and efficacy of the Ambu V R AuraOnce TM laryngeal mask (LMA) compared with endotracheal intubation (ETI) during supratentorial tumor resection in the right lateral decubitus position. Methods: This was a randomized controlled trial of LMA compared with ETI in patients who were scheduled to undergo supratentorial tumor resection in the right lateral decubitus position. The patients were randomized to the LMA (n ¼ 40) and ETI groups (n ¼ 40). The hemodynamic parameters (primary outcome) and mechanical ventilation parameters, anesthetic dose, and complications as well as quality of anesthesia recovery (secondary outcomes) were compared. Results: Patients in the LMA group exhibited lower mean arterial pressure (MAP) and heart rate (HR) compared with ETI. Nine and two patients received esmolol during intubation and extubation, respectively. The airway pressure (AP) in the LMA group was higher compared with the ETI group 60 minutes after the start of surgery. Compared with the ETI group, the sufentanil dose was lower by 24% and the anesthesia recovery rate was better in the LMA group. Conclusions: LMA can improve hemodynamic stability in patients undergoing supratentorial tumor resection in the right lateral decubitus position. If there is a clinical need and no contraindication, LMA could replace ETI.

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“…Most of the studies utilising the replacement of ETT has been conducted in anaesthetised and paralysed neurosurgical patients as it has been associated with favourable haemodynamic profile, less cerebral hyperaemia and a lower incidence of cough but may fret with the inadvertent risk of losing airway. [ 15 16 ] Similarly, the studies utilising such replacement in thyroidectomy were performed again in anaesthetised and paralysed patients[ 8 14 ] except a case report by Maroof et al . [ 7 ] where it was performed following reversal of neuromuscular blockade.…”

Section: Discussionmentioning

confidence: 99%

A randomised preliminary study to compare the performance of fibreoptic bronchoscope and laryngeal mask airway CTrach (LMA CTrach) for visualisation of laryngeal structures at the end of thyroidectomy

et al. 2020

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Background and Aims: Various methods have been used to check vocal cord movements as a routine before awakening the patient at the end of thyroidectomy to rule out recurrent laryngeal nerve (RLN) palsy; out of which, fibreoptic-assisted visualisation via laryngeal mask airway (LMA) being the most desirable. Methods: Thirty patients of either sex, aged 18-65 years, American Society of Anaesthesiologists (ASA) grade I/II, scheduled for thyroidectomy under general anaesthesia (GA) were included and were randomised to receive either fibreoptic assisted (FB) or LMA CTrach-assisted (CT) visualisation of laryngeal structures at the end of thyroidectomy. The primary outcome was grade of view of laryngeal structures and secondary outcomes were time taken to achieve optimal view of laryngeal structures, ease of visualisation, hemodynamic parameters, and complications. Results: In the fibreoptic group, we obtained comparable optimal laryngeal view i.e., grade 1 and 2 in all (100%) patients in comparison to 14 (93.33%) in LMA CTrach group. The “time taken to achieve the optimal view” was significantly lower in the CTrach group when compared to Fibreoptic group (220.67 ± 95.98 vis-a-vis 136.67 ± 68.98). The ease of visualisation of laryngeal structures was comparable ( P = 0.713) and the baseline haemodynamic parameters were comparable between the 2 groups and at various designated intervals. In total, 6.66% and 26.66% patients in group FB and CT group, respectively, required manoeuvres. However, difference was statistically significant ( P < 0.05). Conclusion: Both Fibreoptic-assisted and LMA CTrach-assisted visualization of laryngeal structures in thyroidectomy are equally efficacious in terms of the optimal laryngeal view obtained and ease of visualisation. However, the time taken to achieve optimal laryngeal view was lesser with LMA CTrach.

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ProSeal Laryngeal Mask Airway Attenuates Systemic and Cerebral Hemodynamic Response During Awakening of Neurosurgical Patients

Abstract: Replacing the ETT with the LMA before neurosurgical patients emerge from anesthesia results in a more favorable hemodynamic profile, less cerebral hyperemia, and a lower incidence of cough.

Cited by 14 publications

References 35 publications

Hemodynamic response, coughing and the incidence of cerebrospinal fluid leakage on awakening with an endotracheal tube or laryngeal mask airway in place after transsphenoidal pituitary surgery: a randomized clinical trial

Hemodynamic response, coughing and the incidence of cerebrospinal fluid leakage on awakening with an endotracheal tube or laryngeal mask airway in place after transsphenoidal pituitary surgery: a randomized clinical trial

Comparative study of the Ambu® AuraOnce™ laryngeal mask and endotracheal intubation in anesthesia airway management during neurosurgery

A randomised preliminary study to compare the performance of fibreoptic bronchoscope and laryngeal mask airway CTrach (LMA CTrach) for visualisation of laryngeal structures at the end of thyroidectomy

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