A Comparison of use of the Laryngeal Mask Airway and Endotracheal Intubation in the Thyroid Surgery.
N.F. Muradov, F.D. Gasanov, A.N. Isaeva, F.Kh.Saidova, MD, MD,Fd,MD, Submitting author
Anesthesiology , Endocryn surgery, Scientific Center of Surgery named after M.A. Topchibashev, Baku, Azerbaija, Azerbaijan Republik, Baku
Introduction: In the thyroid surgery compression and displacement of the trachea requires reliable airway patency. Endotracheal intubation (ETI) is consistent with this requirement, but has its drawbacks associated with potential complications and difficulties in performing. The use of the laryngeal mask airway (LMA) opens up new possibilities for maintaining airway patency, without resorting to intubation of the trachea. Goal. To determine the safety and possible benefits of the use of LMA wersus the ETI in thyroid surgery.
Materials and methods. Prospective, randomized clinical trials were conducted in two groups. In 68 patients (group A) after administration of midazolam (0.07-0.1 mg / kg) and propofol (2.0-2.5 mg / kg) a LMA was established with spontaneous breathing preserved. In 64 patients (group B) after the administration of midazolam, propofol and rocuronium (0.5-0.6 mg / kg) ETI was performed with mechanical ventilation. All patients underwent identical general anesthesia based on fentanyl (3-5 μg / kg) and isoflurane (0.8-1.5% by volume). The adequacy of anesthesia was assessed by clinical observation, by studying the variables of the standard (ECG, heart rate, BP, SpO2) and BIS monitoring, ABB and gas composition in the arterial blood and the level of cortisol in the venous blood. The study was approved by the Research Ethics Committee at Scientific Center of Surgery, Ministry of Health Republic of Azerbaijan under the protocol number 0106AZ00884. Patients were recruited only after signing written informed consent.
Results. In groups A and B, during the induction, the BIS index decreased and further stabilized and maintained until the end of anesthesia, respectively, within 65-53% (an average 58.4 ± 3.4%) and 65-45% (an average of 52.7 ± 4.8%). The difference in the value of the BIS index between the groups was statistically unreliable (p> 0.5). The difference in the quantitative indicators of standard monitoring (BP, heart rate, SpO2), ABB ( PH, -HCO3; BE), arterial blood gas composition (PaO2 and PaCO2) and cortisol level in venous blood was also statistically unreliable (p> 0 , 05) between groups. Statistical analysis of quantitative indicators of the adequacy of anesthesia and gas exchange showed that the use of LMA in thyroid surgery is as safe and suitable as ETI. Clinical observtions showed the adequacy of anesthesia in both groups. However, in group A after induction fluctuations in peripheral circulation were less pronounced than in group B, since LMA administration is less traumatic than ETI. The preservation of spontaneous breathing in group A, unlike mechanical ventilation in group B, contributed to the physiological drainage of the tracheobronchial tree without adversely affecting the surfactant function of the pulmonary alveoli. Recovery of consciousness and muscle tone in group A occurred 10-15 minutes after the end of surgery without the need for decurarization. A LMA was removed in the operating room with adequate spontaneous breathing. Group A patients from the operating room were transferred to the general ward, bypassing the ICU. Complications associated with the use of LMA were not observed.
Conclusion. The use of LMA in thyroid surgery is a safe alternative to ETI for general anesthesia. It successfully combines the advantages of traditional methods (intravenous and inhalation) of general anesthesia and can be successfully used in thyroid surgery.
Keywords: Thyroid surgery, general anesthesia, laryngeal mask .