Laryngeal tube suction II or endotracheal intubation for laparoscopic radical prostatectomy in a head down position: A randomised controlled trial

BACKGROUND The laryngeal tube suction II (LTS II) is a supraglottic airway device (SAD) with a gastric drainage tube and enhanced seal properties as compared with other SADs. Therefore, its use has been proposed in situations with an elevated risk of aspiration. OBJECTIVES To compare the safety and efficacy of airway management and controlled mechanical ventilation when using either an LTS II or an endotracheal tube for laparoscopic radical prostatectomy. DESIGN Randomised, controlled, blinded and single-centre study. SETTING Academic tertiary care centre in Leipzig from April 2014 to May 2015. PATIENTS It was planned to include 100 patients but the study was stopped after 50 patients following an interim analysis. These 50 patients were randomised to either the LTS II group or the endotracheal tube group. All male patients aged more than 18 years for elective laparoscopic radical prostatectomy were eligible. Exclusion criteria included a BMI more than 30, American Society of Anesthesiologists class III or greater, a history of gastroesophageal reflux or other factors known to increase the risk of aspiration and a known difficult airway. INTERVENTIONS All patients received general anaesthesia. Airway management was with either a LTS II or an endotracheal tube, according to the randomisation. MAIN OUTCOME MEASURES The primary endpoint was successful insertion of the particular airway device during anaesthesia for laparoscopic radical prostatectomy. RESULTS In 15 of the 28 patients randomised to LTS II, the device had to be removed and an endotracheal tube inserted, mainly because of an airway leak (n = 10) or swelling of the tongue (n = 3). Ventilation was successful in all patients (n = 22) randomised to endotracheal tube. Quality of ventilation was rated better in the endotracheal tube group. CONCLUSION Our data suggest that LTS II should not be the preferred method of airway management in patients undergoing laparoscopic radical prostatectomy. TRIAL REGISTRATION DRKS00008985 (German Clinical Trials Register).

[1]  C. Greim,et al.  Prehospital airway management using the laryngeal tube , 2014, Der Anaesthesist.

[2]  D. Doyle.  Practice Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway , 2003, Anesthesiology.

[3]  J. Beleña,et al.  Comparison of Laryngeal Mask Airway Supreme and Laryngeal Mask Airway Proseal with respect to oropharyngeal leak pressure during laparoscopic cholecystectomy: a randomised controlled trial , 2013, European journal of anaesthesiology.

[4]  R. Caplan,et al.  Guidelines for Management of the Difficult airway An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway , 2013 .

[5]  S. Russo,et al.  Randomized comparison of the i-gel™, the LMA Supreme™, and the Laryngeal Tube Suction-D using clinical and fibreoptic assessments in elective patients , 2012, BMC Anesthesiology.

[6]  M. Muhammad,et al.  A comparison between Laryngeal Tube Suction II Airway and Proseal Laryngeal Mask Airway in laparascopic surgery. , 2011, The Medical journal of Malaysia.

[7]  M. Provenzano,et al.  Use of the King LT for emergency airway management. , 2010, Archives of otolaryngology--head & neck surgery.

[8]  J. Soar,et al.  European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. , 2010, Resuscitation.

[9]  A. Eberhardt,et al.  Tongue engorgement associated with prolonged use of the King-LT laryngeal tube device. , 2010, Annals of emergency medicine.

[10]  Afshin Amini,et al.  Tubo laríngeo com sucção descartável versus reutilizável para ventilação de pacientes submetidos à colecistectomia laparoscópica , 2010 .

[11]  J. Bahr,et al.  The use of the laryngeal tube disposable (LT-D) by paramedics during out-of-hospital resuscitation-an observational study concerning ERC guidelines 2005. , 2009, Resuscitation.

[12]  R. Rabenalt,et al.  Endoscopic extraperitoneal radical prostatectomy: the University of Leipzig experience of 2000 cases. , 2008, Journal of endourology.

[13]  T. Kikuchi,et al.  Randomized Prospective Study Comparing the Laryngeal Tube Suction II with the ProSeal™ Laryngeal Mask Airway in Anesthetized and Paralyzed Patients , 2008, Anesthesiology.

[14]  T. Volk,et al.  A Comparison of Seal in Seven Supraglottic Airway Devices Using a Cadaver Model of Elevated Esophageal Pressure , 2008, Anesthesia and analgesia.

[15]  S. Altmayer,et al.  Prospective randomized comparison of the new Laryngeal Tube Suction LTS II and the LMA‐ProSeal for elective surgical interventions , 2007, Acta anaesthesiologica Scandinavica.

[16]  T. Cook,et al.  Evaluation of the revised laryngeal tube suction: the laryngeal tube suction II in 100 patients. , 2007, British journal of anaesthesia.

[17]  J. Brimacombe,et al.  The ProSeal™ Laryngeal Mask Airway is an Effective Alternative to Laryngoscope-Guided Tracheal Intubation for Gynaecological Laparoscopy , 2007, Anaesthesia and intensive care.

[18]  T. Cook,et al.  Randomized crossover comparison of ProSeal Laryngeal Mask Airway with Laryngeal Tube Sonda during anaesthesia with controlled ventilation. , 2005, British journal of anaesthesia.

[19]  C. Keller,et al.  Large cuff volumes impede posterior pharyngeal mucosal perfusion with the laryngeal tube airway , 2002, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[20]  C. Keller,et al.  Pharyngeal mucosal pressure and perfusion: a fiberoptic evaluation of the posterior pharynx in anesthetized adult patients with a modified cuffed oropharyngeal airway. , 1999, Anesthesiology.

[21]  B. Ho,et al.  Gastro‐oesophageal reflux during day case gynaecological laparoscopy under positive pressure ventilation: laryngeal mask vs. tracheal intubation , 1998, Anaesthesia.

[22]  L. Conlay,et al.  The Effect of Laryngeal Mask Cuff Pressure on Postoperative Sore Throat Incidence , 1997 .

[23]  M. Frass,et al.  Evaluation of esophageal tracheal combitube in cardiopulmonary resuscitation. , 1987, Critical care medicine.

[24]  A. Brain.  The laryngeal mask--a new concept in airway management. , 1983, British journal of anaesthesia.

[25]  F. Zand,et al.  Disposable versus reusable laryngeal tube suction for ventilation in patients undergoing laparoscopic cholecystectomy. , 2010, Revista brasileira de anestesiologia.