None listed
Conditions
Brief summary
When reviewing the literature, it is noteworthy that tracheal intubation with neuromuscular blocking agents has been generally proposed to secure the airway for controlled ventilation, as in neurosurgery. It is also well known that tracheal intubation and direct laryngoscopy have harmful effects on hemodynamic parameters during intubation and extubation periods that may cause ICP elevation and a ruptured aneurysm. There are few prospective, randomized studies that have investigated the availability of supraglottic airway devices in the EVT setting. Only one report indicated that LMA was safely used in three patients undergoing EVT of unruptured cerebral aneurysms . In this prospective, randomized study, we aimed to test the hypothesis that the use of a laryngeal mask airway (LMA) versus a tracheal tube (TT) could result in a lower incidence of hemodynamic changes, decrease the number of respiratory events, and secure the airway as well as the TT in patients undergoing EVT for a cerebrovascular aneurysm
Interventions
Patients undergoing Endovascular treatment (EVT) for unruptured cerebrovascular aneurysms were randomized to secure the airway with a laryngeal mask airway (LMA, a supraglottic airway device which is frequently used to secure airway for general anesthesia, and also as an alternative to tracheal tube for difficult airway interventions) or tracheal tube (TT). LMA is placed after the induction of general anesthesia, and removed at the end of the procedure, which means after the surgery and/ or int
Patients undergoing Endovascular treatment (EVT) for unruptured cerebrovascular aneurysms were randomized to secure the airway with a laryngeal mask airway (LMA, a supraglottic airway device which is frequently used to secure airway for general anesthesia, and also as an alternative to tracheal tube for difficult airway interventions) or tracheal tube (TT). LMA is placed after the induction of general anesthesia, and removed at the end of the procedure, which means after the surgery and/ or intervention is completed, anesthesia is discontinued and the patient is awaked, the same conditions for TT. Anesthesia was induced with propofol and fentanyl and maintained with remifentanil/propofol-based intravenous anesthesia. Rocuronium ( a nondepolarizing neuromuscular blocker, 0.6 mg/kg intravenously, after the induction of general anesthesia, additional doses were not given) was used in group TT to facilitate tracheal intubation. Hemodynamic parameters were measured before and after airway management and throughout the procedure. After the procedure, recovery times were measured. Respiratory events were recorded.
Sponsors
29 May Diyanet Foundation Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to 67 Years
Healthy volunteers
No
Inclusion criteria
American Society of Anthesiologists grades I–III patients who were scheduled to undergo elective endovascular embolization of unruptured intracranial aneurysms were included in the study
Exclusion criteria
Patients in whom a difficult airway was anticipated (e.g., Mallampati score IV, limited mouth opening, history of difficult intubation), who were at increased risk of regurgitation (gastric reflux, hiatal hernia, body mass index > 40 kg m-2), who had asthma or known allergies to the study’s medications, who were pregnant, or who had a Glasgow Coma Scale (GCS) score of <15 upon neurological examination were excluded from the study.
Outcome results
None listed