Investigation of Endotracheal Tube Versus Laryngeal Mask Airway Emergence Times for Surgical Patients

During surgical procedures requiring general anesthesia, an airway device is often placed to allow for adequate ventilation of the patient. Most commonly, endotracheal tubes (ETTs) or laryngeal mask airways (LMAs) are placed by the anesthesia provider. The difference between these two methods of ventilation is based on the location; ETTs pass through the glottis into the trachea, whereas the LMA sits above the glottis. This difference in placement may lend benefit to LMAs over ETTs, one of which includes a faster removal of the airway device. That is, after the surgical procedure is completed, there is a period when the anesthetic agent is turned off in preparation for the patient's awakening and subsequent removal of the airway device, also known as emergence. In this study, we aim to elucidate whether a difference in emergence times exists between using an ETT or LMA after general anesthesia.  Methods: This retrospective study was conducted at OhioHealth Doctors Hospital, located in Columbus, Ohio, USA. Patients 18 years or older who underwent index surgery under general anesthesia between July 1, 2019 and December 31, 2019 were included. Patients were categorized based on the airway type (ETT or LMA). Clinical data and surgical outcomes were analyzed using descriptive statistics and appropriate statistical tests.  Results: A total of 629 patients (282 ETT, 347 LMA) were included. The mean emergence time in the LMA group was found to be significantly shorter compared to that in the ETT group (5.6 vs 7.2 minutes, p<0.001). The LMA also correlated with reduced anesthesia duration, operating room (OR) time, and procedure time, with all p-values <0.001. Regression models identified the airway type and other various independent variables as predictors of emergence time and OR duration. The adjusted R² for emergence time was 5.90%, whereas the adjusted R² for OR duration was 41.26%.  Conclusion: LMA use was associated with significantly shorter emergence times and operative times compared to ETTs. These findings suggest potential clinical benefits for patients, as well as workflow advantages with LMA use in appropriate surgical settings. Further prospective research is warranted to evaluate clinical outcomes, as well as cost-effectiveness.