Both endotracheal tubes (ETTs) and supraglottic airways (SGAs) are safe airway management options for outpatient sinus surgery. Early results from a prospective, randomized, single-blinded study suggest that, for the most part, there is no difference in outcomes or complications between the two methods. The study focused on differences in postoperative complications, such as nausea and vomiting, pain scores, opioid use, sore throat and voice changes. So far, the data reveal that patients with SGAs have fewer adverse effects, but the differences are not significant.
“Anesthesiologists should talk with their surgeons about routine use of LMAs [laryngeal mask airways] for uncomplicated sinus surgery when an LMA would benefit the patient, for instance, someone with asthma or reactive airway disease,” said Kelly McQueen, MD, MPH, professor of anesthesiology and surgery at Vanderbilt University Medical Center, in Nashville, Tenn., where the study was conducted. Dr. McQueen also is director of Vanderbilt Anesthesia Global Health and Development and the Vanderbilt Global Anesthesiology Fellowship. She is an internationally recognized expert on the role of safe anesthesia in global health, particularly in low- and middle-income communities.
Outpatient Setting Not Studied
Supraglottic airways are a safe mode of airway management when delivering general anesthesia to patients in a variety of procedures. However, in nasal surgery, studies have not been conducted about adverse effects. In the ambulatory surgery setting, these outcomes may be particularly important to observe to increase efficiency, maintain safety standards and improve perioperative experience.
“Anesthesiologists should not be concerned that ETTs inherently have more side effects such as sore throat, hoarseness or post-op pain medication consumption, while also recognizing that LMAs offer a safe alternative for sinus surgery when patients are carefully selected,” she said. Dr. McQueen was a co-investigator on the project presented (poster 3) by her Vanderbilt colleagues, Stephen Harvey, MD, and Katherine Dobie, MD, at the 2016 joint meeting of the Society for Ambulatory Anesthesia and the American Society of Anesthesiologists.
The Vanderbilt team used standard selection criteria to carefully select cases and randomly assign them into SGA or ETT for sinus surgery in the outpatient surgery center. After the procedure, patients were evaluated in the PACU according to standard protocol, and they responded to a questionnaire at the first postoperative follow-up visit to the ear, nose and throat (ENT) clinic.
The study randomly assigned 26 patients to ETT and 23 to SGA (Figure). No significant differences occurred in immediate postoperative pain, swallowing, cough or nausea. Patients in the ETT group had a greater incidence of severe throat pain during the first 48 hours, and higher rates of voice change.
Figure. Adverse effects of airway management in an outpatient setting.
ETT, endotracheal tube; SGA, supraglottic airway
“Based on this preliminary data, it appears that patients randomized to SGAs may experience less postoperative pain and voice change,” Dr. McQueen said. “However, thus far, neither varies significantly between groups.”
The sample size of 49 is one limitation to the study, which the researchers would like to overcome. The team, including ENT surgeon collaborators, will continue to compare the use of ETTs and LMAs in other surgical interventions to compare similar outcomes. In addition, future studies will include additional reporting about the subjective experience of the patients.