Diala Al Mardini¹, Peter Catalano¹*, Rohan Wijewickrama¹ and Ayman Fraihat²

¹Department of Otolaryngology, St Elizabeth’s Medical Center, Brighton, MA, USA
²Department of Otolaryngology, Sulaiman Al Habib Medical Center, Dubai, UAE

*Corresponding Author: Peter Catalano, Department of Otolaryngology, St Elizabeth’s Medical Center, Brighton, MA, USA.

Received: May 06, 2022; Published: May 23, 2022

Abstract

Objectives: The use of a flexible laryngeal mask (FLMA) during tonsillectomy and nasal/sinus surgery has been a controversial issue due to concerns regarding its efficacy in securing the airway and preventing potential airway complications like aspiration. This study aims at assessing the efficacy and safety of FLMA in upper airway surgery compared to the use of the standard endotracheal tube (ETT).

Method: Retrospective chart review of 229 patients who had undergone tonsillectomy alone or combined with nasal/sinus surgery, and whose airway was maintained with either a FLMA or ETT at our institution between 2016-2019. Adult and pediatric patients were included. Patient demographics, conversion rate from FLMA to ETT, LMA size modification rate, and LMA vs ETT related complications, induction time and extubation time were recorded for both groups and compared.

Results: 229 patients (128 pediatrics and 101 adults) had tonsillectomy alone or tonsillectomy combined with nasal/sinus surgery. 179 patients received FLMA, while 50 had an ETT during their surgery.

Conversion from LMA to ETT was carried out in only two adult cases (0.009%); one due to inadequate oral-pharyngeal space to perform tonsillectomy, and 1 due to an air leak after tonsillectomy requiring a larger size FLMA. None of the patients in the FLMA group developed aspiration pneumonia, bronchitis, or any other pulmonary complication. Two patients in the FLMA group developed cough 1 month postoperatively due to documented laryngeal reflux. All patients were discharged home on the same day of surgery except 1 adult patient with an ETT who was admitted overnight for monitoring due to postoperative desaturation and tachycardia.

The mean induction time and extubation time were both shorter when FLMA was used. The difference in the induction time was statistically significant (11.5 min ± 09 for ETT vs 7.8 min ± 0.3 for FLMA, P = 0.0003), as was the difference in extubation time (9.8 min ± 1.1 for ETT vs 7.1 min ± 0.4 for FLMA, P < 0.05).

Limitations: Retrospective chart review.

Conclusion: The use of a Flexible laryngeal mask airway is very safe and effective during upper airway surgery with minimal risk of pulmonary or cardiac complications and has the additional benefit of shorter induction and extubation time.

Keywords: Airway Surgery; Flexible Laryngeal Mask Airway; Endotracheal Tube

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Citation

Citation: Peter Catalano., et al. “Comparing the Use of the Flexible Laryngeal Mask Airway Versus the Endotracheal Tube in Upper Airway Surgery".Acta Scientific Otolaryngology 4.6 (2022): 67-72.

Copyright

Copyright: © 2022 Peter Catalano., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.