Laryngeal mask airway facilitates smooth emergence from anesthesia in patients undergoing craniotomy

The results of a prospective randomized controlled study published in the BMC Anesthesiology suggest that, compared to deep extubation, the use of a laryngeal mask airway (LMA) during emergence from anesthesia in patients undergoing craniotomy provides a safer and smoother process. Cheng-Fong Wei and peers found that the LMA group had better oxygen saturation, fewer respiratory complications, and fewer airway interventions compared to the endotracheal tube (ETT) group.

Deep extubation under anesthesia has been shown to maintain stable hemodynamics and intracranial pressure during emergence from anesthesia in patients undergoing craniotomy. However, the use of a laryngeal mask airway (LMA) as a temporary airway replacement during emergence from anesthesia has not been widely studied in this patient population.

The study was conducted on 58 patients undergoing elective craniotomy for brain tumors. After the completion of the surgical procedure, the patients were randomly assigned to either the ETT group (n=29) for deep extubation or the LMA group (n=29) where the endotracheal tube was replaced by a laryngeal mask airway. The primary outcomes were respiratory complications, airway interventions, and hemodynamic changes from emergence from anesthesia to 30 minutes after "Time Zero" (when the patients fully regained muscle power). The secondary outcomes were re-operation incidence in 24 hours, length of stay in the intensive care unit, and postoperative hospital days.

At 5 minutes before Time Zero, oxygen partial pressures (PaO2) and carbon dioxide partial pressures (PaCO2) were comparable between the two groups. After Time Zero, there was no significant change in PaCO2 in both groups, but there was a significantly lower PaO2 in the ETT group compared to the LMA group. The ETT group also had a higher frequency of coughing and snoring, leading to more interventions to maintain adequate respiration. Additionally, the blood pressures and heart rates in the ETT group were generally higher than in the LMA group, but the differences were not significant except for heart rate at 10 minutes after Time Zero. The secondary outcomes between the two groups were similar.

In conclusion, this study provides evidence that the use of a laryngeal mask airway during emergence from anesthesia in patients undergoing craniotomy is a safer and smoother process compared to deep extubation. The study's findings support the potential benefits of using an LMA as a temporary airway replacement during emergence from anesthesia in patients undergoing craniotomy.

Source:

Wei, C.-F., & Chung, Y.-T. (2023). Laryngeal mask airway facilitates a safe and smooth emergence from anesthesia in patients undergoing craniotomy: a prospective randomized controlled study. In BMC Anesthesiology (Vol. 23, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12871-023-01972-x