The effects of laryngeal mask airway versus endotracheal tube on atelectasis in patients undergoing general anesthesia assessed by lung ultrasound: A protocol for a prospective, randomized controlled trial

Xuebin Li, Bin Liu, Yaxin Wang, Wei Xiong, Yuan Zhang, Di Bao, Yi Liang, Ling Li, Gaifen Liu, Xu Jin, Xuebin Li, Bin Liu, Yaxin Wang, Wei Xiong, Yuan Zhang, Di Bao, Yi Liang, Ling Li, Gaifen Liu, Xu Jin

Abstract

Background: The incidence of atelectasis is high in patients undergoing general anesthesia. This may cause oxygenation impairment and further contribute to postoperative pulmonary complications (PPCs). As important airway management devices for general anesthesia, few studies have compared the effects of laryngeal mask airway (LMA) and endotracheal tube (ETT) on atelectasis. Additionally, lung ultrasound has been increasingly used for bedside atelectasis diagnosis. For the above considerations, this trial is designed to compare the effects of LMA and ETT on atelectasis assessed by lung ultrasound scores, further providing more powerful clinical evidence for perioperative respiratory management of non-laparoscopic elective lower abdominal surgery under general anesthesia.

Methods: This is a prospective, single-center, single-blind, randomized controlled trial. From July 2021 to July 2022, 180 patients undergoing elective non-laparoscopic lower abdominal surgery under general anesthesia will be recruited and randomly divided into the ETT and LMA groups at a ratio of 1:1. The primary outcome is the total atelectasis LUS of 12 lung regions 15 min after the establishment of the artificial airway. The total atelectasis LUS at the end of surgery and 30 min after extubation, oxygenation index, postoperative airway complications, PPCs, and length of stay will be analyzed as secondary indicators.

Trial registration: ClinicalTrials.gov identifier: ChiCTR1900020818. Registered on January 20, 2019. Registered with the name of "Laryngeal mask airway versus endotracheal tube for atelectasis." URL: https://www.chictr.org.cn/showproj.aspx?proj=35143.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Study schedule.
Fig 1. Study schedule.
Group L, laryngeal mask airway group; Group E, endotracheal tube group; LUS, lung ultrasound scores; PPCs, postoperative pulmonary complications; T0, entering the operating room; T1, 15 min after the establishment of the artificial airway; T2, the end of the surgery; T3, 30 min after extubation.
Fig 2. Patients flow diagram.
Fig 2. Patients flow diagram.
Group L, laryngeal mask airway group; Group E, endotracheal tube group; LUS, lung ultrasound scores; PPCs, postoperative pulmonary complications, *T1, 15 min after the establishment of the artificial airway; T2, the end of the surgery; T3, 30 min after extubation.

References

    1. Bendixen HH, Hedley-Whyte J, Laver MB. Impaired Oxygenation in Surgical Patients During General Anesthesia with Controlled Ventilation. A Concept of Atelectasis. The New England journal of medicine. 1963;269:991–996. doi: 10.1056/NEJM196311072691901
    1. Haaksma ME, Smit JM, Heldeweg MLA, Nooitgedacht JS, de Grooth HJ, Jonkman AH, et al.. Extended Lung Ultrasound to Differentiate Between Pneumonia and Atelectasis in Critically Ill Patients: A Diagnostic Accuracy Study. Critical care medicine. 2021.
    1. Tusman G, Böhm S, Warner D, Sprung J. Atelectasis and perioperative pulmonary complications in high-risk patients. Current opinion in anaesthesiology. 2012;25(1):1–10. doi: 10.1097/ACO.0b013e32834dd1eb
    1. Hedenstierna G, Rothen HU. Respiratory function during anesthesia: effects on gas exchange. Comprehensive Physiology. 2012;2(1):69–96. doi: 10.1002/cphy.c080111
    1. Magnusson L, Spahn D. New concepts of atelectasis during general anaesthesia. British journal of anaesthesia. 2003;91(1):61–72. doi: 10.1093/bja/aeg085
    1. Hedenstierna G. Oxygen and anesthesia: What lung do we deliver to the post-operative ward? Acta Anaesthesiologica Scandinavica. 2012;56(6):675–685. doi: 10.1111/j.1399-6576.2012.02689.x
    1. Hedenstierna G, Rothen H. Respiratory function during anesthesia: effects on gas exchange. Comprehensive Physiology. 2012;2(1):69–96. doi: 10.1002/cphy.c080111
    1. Hedenstierna G, Edmark L. The effects of anesthesia and muscle paralysis on the respiratory system. Intensive care medicine. 2005;31(10):1327–1335. doi: 10.1007/s00134-005-2761-7
    1. Duggan M, Kavanagh B. Pulmonary atelectasis: a pathogenic perioperative entity. Anesthesiology. 2005;102(4):838–854. doi: 10.1097/00000542-200504000-00021
    1. Généreux V, Chassé M, Girard F, Massicotte N, Chartrand-Lefebvre C, Girard M. Effects of positive end-expiratory pressure/recruitment manoeuvres compared with zero end-expiratory pressure on atelectasis during open gynaecological surgery as assessed by ultrasonography: a randomised controlled trial. British journal of anaesthesia. 2020;124(1):101–109. doi: 10.1016/j.bja.2019.09.040
    1. Li X, Jiang D, Jiang Y, Yu H, Zhang M, Jiang J, et al.. Comparison of low and high inspiratory oxygen fraction added to lung-protective ventilation on postoperative pulmonary complications after abdominal surgery: A randomized controlled trial. Journal of clinical anesthesia. 2020;67:110009. doi: 10.1016/j.jclinane.2020.110009
    1. Zhu C, Zhang S, Dong J, Wei R. Effects of positive end-expiratory pressure/recruitment manoeuvres compared with zero end-expiratory pressure on atelectasis in children: A randomised clinical trial. European journal of anaesthesiology. 2021;38(10):1026–1033. doi: 10.1097/EJA.0000000000001451
    1. De Rosa S, Messina A, Sorbello M, Rigobello A, Colombo D, Piccolo A, et al.. Laryngeal Mask Airway Supreme vs. the Spritztube tracheal cannula in anaesthetised adult patients: A randomised controlled trial. European journal of anaesthesiology. 2019;36(12):955–962. doi: 10.1097/EJA.0000000000001106
    1. Wang X, Huang K, Yan H, Lan F, Yao D, Li Y, et al.. The median effective dose (ED50) of cis-Atracurium for laryngeal mask airway insertion during general Anaesthesia for patients undergoing urinary surgery. BMC anesthesiology. 2020;20(1):68. doi: 10.1186/s12871-020-00982-3
    1. Bai F, Li H, Yi M, Yin H, Wu W. The efficacy of different alveolar recruitment maneuvers in holmium laser lithotripsy surgery under general anesthesia using a laryngeal mask. BMC anesthesiology. 2022;22(1):134. doi: 10.1186/s12871-022-01664-y
    1. Berry A, Brimacombe J, Keller C, Verghese C. Pulmonary airway resistance with the endotracheal tube versus laryngeal mask airway in paralyzed anesthetized adult patients. Anesthesiology. 1999;90(2):395–397. doi: 10.1097/00000542-199902000-00011
    1. Ahmad I, Onwochei D, Muldoon S, Keane O, El-Boghdadly K. Airway management research: a systematic review. Anaesthesia. 2019;74(2):225–236. doi: 10.1111/anae.14471
    1. Monastesse A, Girard F, Massicotte N, Chartrand-Lefebvre C, Girard M. Lung Ultrasonography for the Assessment of Perioperative Atelectasis: A Pilot Feasibility Study. Anesthesia and analgesia. 2017;124(2):494–504. doi: 10.1213/ANE.0000000000001603
    1. Haaksma M, Smit J, Heldeweg M, Nooitgedacht J, de Grooth H, Jonkman A, et al.. Extended Lung Ultrasound to Differentiate Between Pneumonia and Atelectasis in Critically Ill Patients: A Diagnostic Accuracy Study. Critical care medicine. 2022;50(5):750–759. doi: 10.1097/CCM.0000000000005303
    1. Park M, Jung K, Sim W, Kim D, Chung I, Choi J, et al.. Perioperative high inspired oxygen fraction induces atelectasis in patients undergoing abdominal surgery: A randomized controlled trial. Journal of clinical anesthesia. 2021;72:110285. doi: 10.1016/j.jclinane.2021.110285
    1. Yu X, Zhai Z, Zhao Y, Zhu Z, Tong J, Yan J, et al.. Performance of Lung Ultrasound in Detecting Peri-Operative Atelectasis after General Anesthesia. Ultrasound in medicine & biology. 2016;42(12):2775–2784. doi: 10.1016/j.ultrasmedbio.2016.06.010
    1. Acosta C, Maidana G, Jacovitti D, Belaunzarán A, Cereceda S, Rae E, et al.. Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children. Anesthesiology. 2014;120(6):1370–1379. doi: 10.1097/ALN.0000000000000231
    1. Wu L, Hou Q, Bai J, Zhang J, Sun L, Tan R, et al.. Modified Lung Ultrasound Examinations in Assessment and Monitoring of Positive End-Expiratory Pressure-Induced Lung Reaeration in Young Children With Congenital Heart Disease Under General Anesthesia. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2019;20(5):442–449. doi: 10.1097/PCC.0000000000001865
    1. Song I, Kim E, Lee J, Ro S, Kim H, Kim J. Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia-induced atelectasis in infants: a randomised, controlled trial. Anaesthesia. 2017;72(2):214–222. doi: 10.1111/anae.13713
    1. Sun L, Wu L, Zhang K, Tan R, Bai J, Zhang M, et al.. Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery. Pediatric pulmonology. 2020;55(5):1273–1281. doi: 10.1002/ppul.24720
    1. Schulz K, Altman D, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC medicine. 2010;8:18. doi: 10.1186/1741-7015-8-18
    1. Young C, Harris E, Vacchiano C, Bodnar S, Bukowy B, Elliott R, et al.. Lung-protective ventilation for the surgical patient: international expert panel-based consensus recommendations. British journal of anaesthesia. 2019;123(6):898–913. doi: 10.1016/j.bja.2019.08.017
    1. Abbott T, Fowler A, Pelosi P, Gama de Abreu M, Møller A, Canet J, et al.. A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications. British journal of anaesthesia. 2018;120(5):1066–1079. doi: 10.1016/j.bja.2018.02.007
    1. Lee Y, Wang J, Yang Y, Chen A, Lai H. Midazolam vs ondansetron for preventing postoperative nausea and vomiting: a randomised controlled trial. Anaesthesia. 2007;62(1):18–22. doi: 10.1111/j.1365-2044.2006.04895.x
    1. Verma S, Sharma S. Effectiveness of Proseal laryngeal mask airway and laryngeal tube suction in elective non-laparoscopic surgeries of up to ninety minutes duration: A prospective, randomized study. Journal of anaesthesiology, clinical pharmacology. 2018;34(1):58–61. doi: 10.4103/joacp.JOACP_101_16
    1. Gunnarsson L, Tokics L, Gustavsson H, Hedenstierna G. Influence of age on atelectasis formation and gas exchange impairment during general anaesthesia. British journal of anaesthesia. 1991;66(4):423–432. doi: 10.1093/bja/66.4.423
    1. Hansell L, Milross M, Delaney A, Tian DH, Ntoumenopoulos G. Lung ultrasound has greater accuracy than conventional respiratory assessment tools for the diagnosis of pleural effusion, lung consolidation and collapse: a systematic review. Journal of physiotherapy. 2021;67(1):41–48. doi: 10.1016/j.jphys.2020.12.002

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