Effectiveness and Superiority of Ventilation with Laryngeal Mask Airway in Partial Laryngectomy

Background: Laryngeal carcinoma occupies the space of glottis. It may lead to difficult airway, and is prone to bleed if intubated with endotracheal tube (ETI). Intubation can also result in the possibility of tumor cultivation in the lung. Use of laryngeal mask airway (LMA) could avoid the disadvantages of endotracheal intubation, which would benefit patients undergoing partial laryngectomy. Methods: This was a randomized controlled clinical trial. Thirty adult patients scheduled to receive partial laryngectomy were enrolled. All study subjects received an ASA rating of grade III. Subjects were randomly assigned to the LMA group or the ETI group. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (SpO2), tidal volume and end tidal CO2 were recorded at 6 to 8 time points throughout the procedure. Arterial blood gas was analyzed at the time of tracheotomy and the same time interval after tracheotomy. Comparison analysis was performed using the Student’s t-test for continuous variables. Results: ETI and LMA both provided satisfactory ventilation, and there was no significant difference in time to tracheotomy time between the two groups. Arterial blood gas analysis showed no significant differences in pH, PCO2, PO2, SaO2, BE, or HCO3between the two groups. Significant differences were observed regarding hemodynamics, however; immediately after intubation, HR, SBP and HBP were significantly lower in the LMA group than in the ETI group (74.47 ± 11.77 vs. 84.67 ± 14.23, 99.67 ± 9.21 vs. 137.53 ± 35.50, 61.20 ± 8.10 vs. 82.53 ± 22.48, respectively). Five minutes after intubation SBP was still significantly lower in the LMA group (94.00 ± 11.28 vs. 110.53 ± 24.61). Conclusions: Ventilation with LMA in partial laryngectomy was as effective as ETI, and hemodynamics were more stable in the LMA group compared with the ETI group.