Sparing the larynx during gynecological laparoscopy: a randomized trial comparing the LMA Supreme^™and the ETT

Background We designed a prospective randomized single-blind study to compare efficiency and post-operative upper airway morbidity when the laryngeal mask airway (LMA) Supreme (TM) is used as an alternative to the endotracheal tube (ETT). Methods One hundred and thirty-eight elective pelvic laparoscopic ASA I-II female patients were assigned to receive either the LMA Supreme (R) or the ETT for airway management. Balanced anesthesia and ventilation techniques were standardized to control end-tidal CO2 and BIS value in the range 4.5-5 kPa and 40-50, respectively, and to maintain adequate hemodynamic stability. A single surgeon blinded to the airway management technique performed all surgical procedures. The ventilation efficiency of each airway was evaluated. Anesthesia- and surgery-related times were calculated and anesthesia details were recorded. Post-operative pain and pharyngolaryngeal morbidity were measured in a blind fashion using a numerical rating scale (NRS) (0-100). Results Surgery duration was similar in both groups. Airway management duration was shorter with the LMA Supreme (R). Post-operative pharyngolaryngeal morbidity incidence and all symptoms' intensity were significantly increased after ETT as compared with LMA Supreme (R) anesthesia. At the end of the PACU stage, the incidence and mean NRS of post-operative hoarseness were reduced when LMA Supreme (R) was used as an alternative to the ETT (16% vs. 47%; P < 0.01 and 9 vs. 19, P < 0.01, respectively). Conclusion We demonstrated that choosing an LMA Supreme (R) was an efficient pharyngolaryngeal morbidity-sparing strategy. Moreover, we showed that the LMA Supreme (R) and the ETT were equally effective airways for a routine gynecological laparoscopy procedure.