title: Anesthesia for intranasal surgery: a comparison between tracheal intubation and the flexible reinforced laryngeal mask airway.
abstract: The purpose of the study was to assess the suitability and safety of the flexible reinforced laryngeal mask airway (FRLMA) for intranasal surgery (INS) anesthesia. A secondary objective was to compare the incidence of complications of removal of the FRLMA with tracheal extubation in awake and anesthetized patients. One hundred fourteen ASA physical status I and II patients requiring INS were randomly assigned into three groups: Group I = FRLMA, Group II = endotracheal tube (ET) extubated awake, and Group II = ET extubated deeply anesthetized. In Group I, the incidence of coughing and oxyhemoglobin desaturation at removal was significantly reduced compared with that in Groups II and III (P < 0.05). There were no episodes of postremoval laryngospasm in Group I; in Group III, the incidence was 19% (P < 0.05), whereas in Group II, it was 6% (not significantly different). The number of patients with oxyhemoglobin desaturation < or = 92% on admission to the postanesthesia care unit was 0% in Group I, 26% in Group II (P < 0.05), and 16% in Group III (not significantly different). At bronchoscopy, the incidence of blood visible in the airway was low and similar among the three groups (3%, 6%, and 3%, respectively). There were no significant differences in the incidence of airway complications between Groups II and III.
  
  
  CONCLUSIONS
  We compared airway management for intranasal surgery anesthesia using a new device, the flexible reinforced laryngeal mask airway, with the current standard of tracheal intubation. The study demonstrates that the flexible reinforced laryngeal mask airway can provide a safe, protected airway with a smoother emergence from anesthesia than tracheal intubation.
authors.affiliation: Department of Anaesthesia, St. Joseph's Health Centre, University of Western Ontario, London, Canada. webster1@julian.uwo.ca
authors.forename: A C
authors.initials: AC
authors.lastname: Webster
authors.forename: P K
authors.initials: PK
authors.lastname: Morley-Forster
authors.forename: V
authors.initials: V
authors.lastname: Janzen
authors.forename: J
authors.initials: J
authors.lastname: Watson
authors.forename: S L
authors.initials: SL
authors.lastname: Dain
authors.forename: D
authors.initials: D
authors.lastname: Taves
authors.forename: D
authors.initials: D
authors.lastname: Dantzer
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D001999:Bronchoscopy; D003371:Cough / Q000209:etiology; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D015994:Incidence; D007442:Intubation, Intratracheal / Q000009:adverse effects; D017214:Laryngeal Masks / Q000009:adverse effects; D007826:Laryngismus / Q000209:etiology; D008297:Male; D009666:Nose / Q000601:surgery*; D010108:Oxyhemoglobins / Q000032:analysis; D010612:Pharyngitis / Q000209:etiology; D018583:Pliability; D019106:Postoperative Hemorrhage / Q000209:etiology; D012119:Respiration; D012121:Respiration, Artificial; D012449:Safety; D014851:Wakefulness