LMA vs ETT for airway management during general anesthesia for surgical resection of supratentorial tumor; a randomized controlled study

Abstract

Background & objective: Hypertension is one of the serious complications observed during intubation as well as during awakening from general anesthesia (GA) and extubation. There have been very limited studies reporting the use of Laryngeal Mask Airway (LMA) in craniotomies, although its use has been documented to be associated with less frequency of hypertension compared to endotracheal intubation. We assessed the incidence of emergence hypertension and hemodynamic stability when using Ambu Aura-i intubating LMA compared to the endotracheal tube (ETT) for ventilating craniotomy patients undergoing supratentorial brain tumor surgeries. Methodology: One hundred and twenty patients participated in this randomized controlled study and were assigned to two groups, the LMA group in which the Ambu Aura-i was used for airway management for GA, and the ETT group in which the ETT were used. The incidence of hypertension on airway device insertion, emergence hypertension and postoperative complications, including cough, sore throat, and hoarseness, were recorded. Results: The LMA group showed a lower incidence of emergence hypertension when compared to the ETT group (48.3% vs 81.7% respectively; P ˂ 0.05). LMA was associated with a lower heart rate (HR), and fewer patients required vasoactive agents during emergence. Moreover, the LMA group expressed a decreased incidence of hypertension with insertion compared to the ETT group (1.7% versus 18.3% respectively; P ˂ 0.05), besides a lower incidence of postoperative cough, sore throat, and hoarseness. Conclusion: The use of Ambu Aura-i intubating LMA for ventilating craniotomy patients undergoing supratentorial brain tumor surgeries showed a lower incidence of emergence hypertension, stable hemodynamics during induction and emergence of anesthesia, and less postoperative complications compared to endotracheal intubation. Keywords: Airway Management; Craniotomy; Hypertension; Intubation, Intratracheal; Laryngeal Masks. Citation: Abdelhakim AK, Esmail A, Elshafaei K, Fadel N, Wahdan AS. LMA vs ETT for airway management during general anesthesia for surgical resection of supratentorial tumor; a randomized controlled study. Anaesth. pain intensive care 2024;28(4):744−751; DOI: 10.35975/apic.v28i4.2518 Received: May 24, 2024; Reviewed: June 05, 2024; Accepted: June 15, 2024