Use of laryngeal mask airway for non-endotracheal intubated anesthesia for patients with pectus excavatum undergoing thoracoscopic Nuss procedure

Abstract

Background:The aim of the present study was to determine the safety and feasibility of the use of laryngeal mask airway (LMA) for non-endotracheal intubated anesthesia for patients with pectus excavatum (PE) undergoing thoracoscopic Nuss procedure.Methods: Between July 2015 and December 2015, 30 selected patients with PE were planned to undergo a thoracoscopic Nuss procedure using LMA for non-endotracheal intubated anesthesia in the Guangdong General Hospital. The clinical data were analyzed to evaluate the safety and feasibility of this technique.Results: Of the 30 selected patients, two were female, the mean age was 16.04±5.09 years and the average Haller index was 3.37±0.88. A total of 27 cases (90%) succeeded at the first attempt, one patient required conversion to an endotracheal tube (ETT) because of continuous air leak. The peripheral O 2 saturation (SpO 2 ), end-tidal carbon dioxide (EtCO 2 ) values, heart rate (HR), and mean arterial blood pressure (MAP) remained stable throughout the procedure in all cases. All of the 30 patients were successfully corrected without requiring conversion to an open surgery. Two patients experienced postoperative nausea and one reported a sore throat. Neither gastro-esophageal reflux nor in-hospital mortality occurred. Conclusions:The use of LMA for non-endotracheal intubated anesthesia for selected patients with PE undergoing thoracoscopic Nuss procedure is clinically safe and technically feasible. as intubation-related trauma, increased risk of pneumonia, impaired cardiac performance, postoperative nausea and voice hoarseness, have prompted some surgeons to prefer the thoracoscopic procedure under non-endotracheal intubated anesthesia. The laryngeal mask airway (LMA) is a relatively new device that was introduced to clinical practice in the 1980s. Unlike ETT, the LMA is supraglottic and usually inserted blindly, thereby avoiding laryngoscopy. Therefore, it inevitably causes less intubation-related adverse events, such as vomiting, cough, hoarseness, sore throat, increased risk of pneumonia and impaired cardiac performance.Considering these benefits, the choice of thoracoscopic Nuss procedure in combination with non-endotracheal intubated anesthesia could have the latent possibility of decreasing the invasiveness of the procedure and allowing quicker postoperative recovery. Therefore, we conducted the present study to determine the safety and feasibility of using the LMA for non-endotracheal intubated anesthesia for patients with PE undergoing the thoracoscopic Nuss procedure. Methods Patient recruitmentThe study was designed as a pilot study and approved by the Human Ethics Committee of Guangdong General Hospital (Guangzhou, China). Written informed consent was obtained from the parents or legal guardians after they had been informed about the investigational nature of the study, the differences between LMA and ETT, the possibility that require conversion to an ETT may be necessary during the procedure, and the foreseeable outcomes. Eligibility criteria included a de...

A comparison between laryngeal mask airway and endotracheal intubation for anaesthesia in adult patients undergoing NUSS procedure

“…Compared to ETT, LMA shows superiority in certain aspects, which makes it specifically suitable for application in some small thoracic surgeries. There have been clinical cases around the world in which LMA was successfully applied in the VATS procedure for patients with spontaneous pneumothorax or thoracic spine orthopaedics (7,8,15,16). We discovered from clinical practice that LMA possesses multiple advantages for airway management: easy to operate; no laryngoscope required; the whole procedure took only approximately 20 seconds and usually could be accomplished successfully.…”

“…The data from the enrolled patients who suffered severe complications during surgery such as arrhythmia, electrolyte disorders or uncontrolled blood loss and needed to convert to open-chest surgery were excluded from our final analysis. Based on "rule of thumb" in statistics and a previously published article (8), at least 30 patients in each group are considered adequate for statistical analysis. We were recruiting patients until the sample size for each group reached our ideal number.…”

Hyomental distance measured by ultrasound for size selection of laryngeal mask airway in female patients: a randomized controlled study

“…Five (14.29%) hyomental-distance group patients and seven (21.21%) weight group patients were injured (Figure 3b). OLP values for two groups were 22 (19)(20)(21)(22)(23)(24) cmH2O and 22 (19.5-24) cmH2O, respectively (Figure 4a). Insertion attempts were the same for both groups (Figure 4b).…”

“…In addition, LMA has been preferentially used in short and small surgery or rst aid scenarios [22]. But, in recent years, because of easier operations with less postoperative complications, higher levels of comfort, and shorter recovery time than seen with endotracheal intubation [23], LMA is increasingly used in major operations,such as breast cancer surgery, limb fracture surgery, and even spinal surgery [24]. Breast surgery is one of the best indications for using LMA because such surgery often involves longer operation time, thus necessitating more signi cant requirement for accurate LMA size selection.…”

Italian survey on non-intubated thoracic surgery: results from INFINITY group

“…The use of the laryngeal mask (LMA), described in other studies [ 26 , 27 ], has been reported only in 10% of cases to maintain spontaneous breathing and to avoid the risks associated with OTI and mechanical ventilation. LMA requires a deeper anesthetic plan to allow its tolerance, it is used by 42% of anesthesiologists.…”