Use of LMA Instead of Intubation During Surgery

In the realm of anesthesia and surgery, the choice between using a laryngeal mask airway (LMA) or endotracheal intubation (ETT) has been a subject of debate and consideration. Both methods serve the essential function of maintaining a patient’s airway during surgery, but they differ significantly in their approach and clinical application.

A laryngeal mask airway (LMA) is a supraglottic airway device that is inserted through the mouth and positioned over the laryngeal inlet to create a seal, allowing for positive pressure ventilation. Unlike endotracheal intubation, which involves the insertion of a tube through the trachea, LMA placement is less invasive and generally easier to perform.

There are many advantages to using an LMA rather than performing intubation for surgery, which include reduced risk of trauma to the airway and surrounding structures. Unlike endotracheal tubes, which can potentially cause mechanical damage, swelling, bleeding and subsequent airway occlusion, LMAs sit above the glottis without entering the trachea, minimizing the likelihood of injury [1]. Further, an LMA can be helpful in patients with severe airway stenosis, where positioning an ETT may be impossible, as LMAs can be inserted blindly without the need for direct visualization of the vocal cords [2]. Thus, an LMA may be recommended as an alternative for adult patients with a history of a difficult intubation and whose current intubation has failed [3]. Further, inserting an LMA is typically faster and requires less expertise compared to endotracheal intubation. This can be particularly beneficial in emergency situations or when anesthesia induction time is limited. Some research has shown that the use of LMA during anesthesia induction for surgery is associated with similar hemodynamic alternations and recovery time as ETT intubation [4]. However, for short surgeries, the use of an LMA with narcotics but without muscle relaxants and inhaled gasses helps to reduce complications of anesthesia and improve recovery time [5]. Lastly, postoperative patients who underwent surgery with general anesthesia may experience less discomfort and sore throat when an LMA is used instead of an endotracheal tube.

The use of LMAs offers several advantages over endotracheal intubation in the context of anesthesia and surgery. From reduced risk of trauma, mechanical damage, and complications to quicker insertion, LMAs can be an effective alternative for maintaining the airway during surgery. While both methods have their place in clinical practice, the benefits of LMA make it a valuable tool for anesthesiologists and surgeons seeking to optimize patient outcomes and comfort within perioperative care.

References

1. Menna C, Fiorelli S, Massullo D, Ibrahim M, Rocco M, Rendina EA. Laryngeal mask versus endotracheal tube for airway management in tracheal surgery: a case-control matching analysis and review of the current literature. Interact Cardiovasc Thorac Surg. 2021;33(3):426-433.
2. Stoelben E, Koryllos A, Beckers F, Ludwig C.. Benign stenosis of the trachea. Thorac Surg Clin 2014;24:59–65.
3. Zaman, B., Noorizad, S., Safari, S., Javadi Larijani, S. M. H., & Seyed Siamdoust, S. A. (2022). Efficacy of Laryngeal Mask Airway Compared to Endotracheal Tube: A Randomized Clinical Trial. Anesthesiology and pain medicine, 12(1), e120478.
4. Dumas GA, Bryant AS, Ibey J, Long JA, Vicinanzo MG, Boyd GL. Safety Comparison of Laryngeal Mask Use With Endotracheal Intubation in Patients Undergoing Dacryocystorhinostomy Surgery. Ophthalmic Plast Reconstr Surg. 2018;34(4):324–8.
5. Kang SH, Park M. Comparison of early postoperative recovery between laryngeal mask airway and endotracheal tube in laparoscopic cholecystectomy: A randomized trial. Medicine (Baltimore). 2019;98(25):e16022.