FACTORS ASSOCIATED WITH PLACEMENT FAILURE OF SECOND-GENERATION LARYNGEAL MASK AIRWAY: A RETROSPECTIVE CLINICAL STUDY

Abstract

Objective: The laryngeal mask airway (LMA) is important for airway management during anesthesia practice. Rarely, when it cannot be placed, it requires alternative interventions. In this study, we aimed to identify factors associated with second-generation LMA placement failure. Methods: Between 2021 and 2023, medical records of consecutive patients who underwent ureteroscopy for urolithiasis under general anesthesia were retrospectively reviewed. Exclusion criteria were: age <18 years and endotracheal intubation as the first preference for airway management. Patients were divided into two groups: (1) those who were successful in LMA placement; and (2) those in whom LMA placement failed. LMA placement failure and associated factors, including body mass index (BMI), gender, mallampati score, thyromental distance, cervical spine mobility, structural status of teeth, American Society of Anesthesiology score (ASA), and history of difficult airway, were evaluated. Results: 188 patients analysed: Male gender (67%), ASA-2 was the majority (56%), and the patients had a mean age of 52.9±14.44 and a BMI of 28.9±5.62 kg/m2. Placement of LMA was successful on initial attempt in 173 (92%); LMA number 4 was most commonly used (57%). Fifteen patients required intubation when the LMA did not settle after three attempts. Comparison of the successful and failed placement groups showed: 14/15 (93.3%) were male (p=0.024). A significant prolongation of anesthesia occurred in patients in whom LMA was not placed (p=0.017). Conclusion: LMA placement failure occurred in 8% of this cohort and most of these patients were male. After LMA placement failure, anesthesia time is significantly prolonged.

Keywords

• Laryngeal Mask Airway
• difficult
• urogenital surgery
• adult

İkinci jenerasyon Laringeal Maske yerleştirme başarısızlığıyla ilişkili faktörler: Retrospektif bir klinik çalışma

Öz

Amaç: Laringeal maske hava yolu (LMA), anestezi uygulaması sırasında hava yolu yönetimi açısından önemlidir. Nadiren yerleştirilemediğinde alternatif müdahaleler gerektirir. Bu çalışmada ikinci nesil LMA yerleştirme başarısızlığıyla ilişkili faktörleri belirlemeyi amaçladık. Yöntem: 2021-2023 yılları arasında genel anestezi altında ürolitiazis nedeniyle üreteroskopi yapılan ardışık hastaların tıbbi kayıtları retrospektif olarak incelendi. Hariç tutma kriterleri şunlardı: yaş <18 ve hava yolu yönetiminde ilk tercihin endotrakeal entübasyon olması. Hastalar iki gruba ayrıldı: (1) LMA yerleştirmede başarılı olanlar ve (2) LMA yerleştirmenin başarısız olduğu kişiler. LMA yerleştirme başarısızlığı ve vücut kitle indeksi (BMI), cinsiyet, mallampati skoru, tiromental mesafe, servikal omurga hareketliliği, dişlerin yapısal durumu, Amerikan Anesteziyoloji Derneği skoru (ASA) ve zor hava yolu öyküsü gibi ilişkili faktörler değerlendirildi. Bulgular: Analiz edilen 188 hasta: Erkek cinsiyet (%67), ASA-2 çoğunluktaydı (%56), hastaların ortalama yaşı 52,9±14,44 ve BMI 28,9±5,62 kg/m2 idi. LMA'nın yerleştirilmesi 173 hastada (%92) ilk denemede başarılı oldu; En sık kullanılan LMA 4 numaraydı (%57). Üç denemeden sonra LMA yerleşmeyince 15 hastada entübasyon gerekti. Başarılı ve başarısız yerleştirme gruplarının karşılaştırılması şunu gösterdi: 14/15 (%93,3) erkekti (p=0,024). LMA takılmayan hastalarda anestezi süresinde anlamlı uzama meydana geldi (p=0,017). Sonuç: LMA yerleştirme başarısızlığı bu grubun %8'inde meydana geldi ve bu hastaların çoğu erkekti. LMA yerleştirme başarısızlığından sonra anestezi süresi önemli ölçüde uzar. Anahtar Kelimeler: Laringeal Maske, zor, ürogenital cerrahi, erişkin

Anahtar Kelimeler

• Laryngeal Mask Airway
• difficult
• urogenital surgery
• adult

Kaynakça

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