title: Flexible laryngeal mask as an alternative to reinforced tracheal tube for upper chest, head and neck oncoplastic surgery.
abstract: OBJECTIVE
  The flexible laryngeal mask airway has been mostly used in spontaneous ventilated children during short procedures to avoid the risk of kinking; little information has been reported about its airway morbidity. The aim of the study was to compare this airway device with the reinforced tracheal tube in mechanically ventilated adult patients.
  
  
  METHODS
  120 adult patients undergoing general anaesthesia for breast, head and neck oncoplastic surgery, expected to last up to 3 h, were stratified into two airway groups: flexible laryngeal mask airway (n = 60) or reinforced tracheal tube (n = 60). Within each group, patients were randomly allocated to one of the two maintenance anaesthetic subgroups: propofol (n = 30) or sevoflurane (n = 30). Ease of insertion and haemodynamic stress response to placement, ventilation and postoperative morbidity were studied.
  
  
  RESULTS
  Easy insertion rate was greater for the flexible laryngeal mask airway (93% vs. 77%, P = 0.01), and the overall success in insertion rate was 100% for both groups. Haemodynamic changes were significantly higher after inserting reinforced tracheal tube (P < 0.001). Oxygen saturation and capnography were comparable in both groups but airway pressure was lower with flexible laryngeal mask airway (P = 0.002). Sore throat, cough and dysphonia were lest frequent with flexible laryngeal mask airway (P < 0.01); also more patients in this group felt comfortable. Sevoflurane gave better results in emergence time, regardless of the airway device used.
  
  
  CONCLUSIONS
  During anaesthesia in mechanically ventilated adult patients, both devices function adequately, are stable and protect the airway. Flexible laryngeal mask airway results in less postoperative morbidity than reinforced tracheal tube.
authors.affiliation: University Hospital of Bellvitge, Department of Anaesthesiology, Barcelona, Spain. carmen.martin@e-motiva.com
authors.forename: C
authors.initials: C
authors.lastname: Martin-Castro
authors.forename: A
authors.initials: A
authors.lastname: Montero
mesh_terms: D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000601:surgery*; D019296:Capnography; D003371:Cough / Q000209:etiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D017214:Laryngeal Masks / Q000009:adverse effects; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D017060:Patient Satisfaction; D010612:Pharyngitis / Q000209:etiology; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D000077149:Sevoflurane; D014832:Voice Disorders / Q000209:etiology
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D010100:Oxygen; D015742:Propofol