Med Bull Sisli Etfal Hosp. Accepted Articles: SETB-99249 | DOI: 10.14744/SEMB.2024.99249

Can Laryngeal Mask Airway be the First Choice for Tracheal Stenosis Surgery? A Historical Cohort Study

Ozal Adiyeke¹, Onur Sarban¹, Ergun Mendes¹, Taner Abdullah¹, Ali Kahvecioglu¹, Aynur Bas², Hasan Akin², Funda Gumus Ozcan^1
1Department of Anesthesiology and Reanimation, University of Health Sciences Türkiye, Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye
²Department of Thoracic Surgery, University of Health Sciences Türkiye, Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye

Objective: To compare the usage of laryngeal mask airway (LMA) and orotracheal intubation (OTI), which are separate airway management methods in tracheal reconstruction surgeries, in terms of perioperative management, mortality, and morbidity.
Methods: Adult patients who underwent tracheal reconstruction surgery between June 2020 and June 2022 were included in the study, retrospectively. Patients with lost data or primary tracheal malignancy were excluded. Patients who underwent tracheal reconstruction were divided into two groups: LMA and OTI.
Results: Of a total of 57 included patients, the OTI and LMA groups had 30 (52.63%) and 27 patients (47.37%), respectively. The rate of intubated transfer to the intensive care unit and the length of stay in the intensive care unit were significantly higher in the OTI group (p=0. 014, p=0. 031) than those of the LMA group; further, in tracheal cultures, reproduction was also significantly higher in the OTI group (23.33%) (p=0. 007). The postoperative mortality rates were similar in both groups.
Conclusion: Since the absence of tension in end-to-end anastomosis of the trachea is vital for successful surgery, the LMA application (which has no tracheal contact) can be considered superior to OTI. In this study, LMA was successfully applied in all patients. Considering that the aim of anesthesia management should be to provide adequate oxygenation and normocarbia with minimally invasive intervention, we suggest airway management using LMA as the first option for tracheal reconstruction surgery because of the advantages described in this study.

Keywords: Airway management, laryngeal mask airways, orotracheal intubation, postintubation stenosis, tracheal resection

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Laringeal Maske Trakeal Stenoz Cerrahisinde Ýlk Tercih Olabilir mi? Retrospektif Kohort Çalýþmasý

Ozal Adiyeke¹, Onur Sarban¹, Ergun Mendes¹, Taner Abdullah¹, Ali Kahvecioglu¹, Aynur Bas², Hasan Akin², Funda Gumus Ozcan^1
1Türkiye Saðlýk Bilimleri Üniversitesi, Baþakþehir Cam ve Sakura Þehir Hastanesi, Anesteziyoloji ve Reanimasyon Kliniði, Ýstanbul
²Türkiye Saðlýk Bilimleri Üniversitesi, Baþakþehir Cam ve Sakura Þehir Hastanesi, Göðüs Cerrahisi Kliniði, Ýstanbul

Amaç: Çalýþmamýzda trakeal rekonstrüksiyon ameliyatlarýnda laringeal maske (LMA) ve orotrakeal entübasyon (OTI) kullanýmýnýn perioperatif mortalite ve morbidite açýsýndan karþýlaþtýrmayý amaçladýk.
Yöntemler: Haziran 2020 ile Haziran 2022 tarihleri arasýnda trakeal rekonstrüksiyon ameliyatý geçiren eriþkin hastalar retrospektif olarak çalýþmaya dahil edildi. Veri kaybý olan ve primer trakeal malignitesi olan hastalar çalýþma dýþý býrakýldý. Trakeal rekonstrüksiyon yapýlan hastalar iki gruba ayrýldý: grup LMA ve grup OTI.
Bulgular: Çalýþmaya dahil edilen toplam 57 hastadan OTI ve LMA gruplarýnda sýrasýyla 30 (%52,63) ve 27 (%47,37) hasta vardý. Entübe olarak yoðun bakým ünitesine transfer oraný ve yoðun bakým ünitesinde kalýþ süresi OTI grubunda LMA grubuna göre anlamlý olarak daha yüksekti (p=0. 014, p=0. 031); ayrýca, trakeal kültürlerde üreme OTI grubunda anlamlý olarak daha yüksekti (%23.33) (p=0. 007). Ameliyat sonrasý mortalite oranlarý her iki grupta da benzer gözlendi.
Sonuçlar: Trakeanýn uç uca anastomozunda gerilim olmamasý ve trakeal kontaminasyonun olmamasý baþarýlý bir cerrahi için hayati önem taþýdýðýndan, LMA uygulamasý OTI'ye göre daha üstün kabul edilebilir. Bu çalýþmada LMA tüm hastalarda baþarýyla uygulanmýþtýr. Anestezi yönetiminin amacý minimal invaziv giriþimle yeterli oksijenasyon ve normokarbiyi saðlamaktýr. Bu nedenle çalýþmamýzýn sonucuna göre trakeal rekonstrüksiyon cerrahisinde ilk seçenek olarak LMA kullanýmýný öneriyoruz. (SETB-2024-03-057)

Anahtar Kelimeler: Hava yolu yönetimi, laringeal maske, orotrakeal entübasyon, postentübasyon stenozu, trakeal rezeksiyon

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