Comparative Study between Laryngeal Mask Airway Flexible and Endotracheal Tube in Anesthesia for Tonsillectomy

Abstract

BACKGROUND: Endotracheal tube (ETT) is the standard means to secure the airway in children undergoing tonsillectomy. However, endotracheal intubation is not without risk. This has been challenged by the introduction of the laryngeal mask airway Flexible (LMA Flexible). It does not kink, less traumatic during insertion and better tolerated during emergence.The aim of this study is to compare the use of laryngeal mask airway flexible (LMA Flexible) and endotracheal tube (ETT) in tonsillectomy to determine whether using the (LMA Flexible) can reduce the incidence of airway complications compared with (ETT) without compromising airway protection and improves recovery without affecting surgical access. METHODS: 60 children, aged 4-12 years and scheduled to undergo tonsillectomy, were randomly assigned to 3 groups;20 in Group (A) where the airways were secured with LMA Flexible, 20 in Group (B) where the airways were secured with oral armored endotracheal tube (OAETT) and 20 in Group (C)where the airways were secured with nasal endotracheal tube (NETT). We registered Insertion characteristics,insertion time,surgical access, number of adjustments of Boyle Davis gag, surgical time, hemodynamic responses, extubation time, recovery time and incidence of complications RESULTS: The LMA Flexible was easier to insert with less number of attempts for correct placement (pvalue = 0.04) with no need for Neuromuscular blocking agents compared to endotracheal intubation (p value = 0.03). There was little difference between LMA and ETT use as regards surgical access and adequate visualization and there was no difference in mean procedure time between groups(p value = 1). But we found that LMA Flexible use had significant lesser extubation time and recovery time than ETT (p value =0.025).Also our study showed more stable hemodynamics in LMA Flexible group than ETT groups, with lower frequencies of postoperative cough bronchospasm, laryngospasm, and laryngeal edema and lower incidence of soft tissue and teeth trauma in LMA flexible group, With lower incidence of airway soiling by blood compared to ETT (p value <0.001). Also no significant differences in postoperative nausea or vomiting in LMA Flexible group when compared to ETT groups(p value =0.6) with a significantly lower incidence of sore throat both in recovery room and 24 hours later in LMA Flexible group when compared to ETT groups(p value <0.001). CONCLUSION: The use of LMA Flexible during anesthesia for tonsillectomy does not appear to have any major disadvantages compared to the use of the ETT under the same conditions. In fact LMA Flexible may be superior for some outcome variables. So LMA Flexible is a well-tolerated and effective alternative to the ETT in anesthesia for tonsillectomy.