Laryngeal mask airway for general anesthesia in interventional neuroradiology procedures

To evaluate whether using laryngeal mask airway (LMA) made a difference in terms of airway security, hemodynamic changes, complications, and recovery times compared to tracheal intubation during the procedure in patients undergoing general anesthesia for endovascular treatments  of unruptured cerebrovascular aneurysms.

The electronic medical records database, patient files, and anesthesia charts were examined between May 2008 and September 2016 to identify patients with the following inclusion criteria: 1) aged 18-70 years; 2) American Society of Anesthesiologists (ASA) classification I-III; 3) diagnosis of unruptured CVA; 4) Glasgow coma scale of 15 without neurological deficit; and 5) underwent elective EVT under general anesthesia.

Tracheal tube (TT) was used in 46 patients (group TT, n=46) and LMA in 42 patients (group LMA, n=42). Mean arterial pressure (MAP) levels were increased to greater than 20% of baseline in 14 patients (30.4%) after intubation and in 6 (13%) after extubation in group TT. All LMA patients remained within normal MAP limits (p less than 0.05). Six patients (13%) displayed coughing or straining at extubation in group TT whereas none in group LMA (p less than 0.05). Recovery and discharge times were similar (p greater than 0.05). Conclusion:  Laryngeal mask airway  and TT provided comparable airway security during procedure. Laryngeal mask airway attenuated stress response in hemodynamic parameters at intubation and extubation and smoother emergence compared to TT without delay in recovery.