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GENERAL ARTICLES

Anesthesia for Intranasal Surgery: A Comparison Between Tracheal Intubation and the Flexible Reinforced Laryngeal Mask Airway

Anthony C. Webster, MBChB, FRCPC, FRCA^*, Patricia K. Morley-Forster, MD, FRCPC^*, Victor Janzen, MD, FRCSC, James Watson, MD, FRCPC^*, Steven L. Dain, MD, FRCPC^*, Donald Taves, MD, FRCPC, and Dale Dantzer, BSc^*

Departments of *Anaesthesia, Otolaryngology, and Radiology, St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada

Address correspondence to Dr. A. C. Webster, Department of Anaesthesia, St. Joseph's Hospital, 268 Grosvenor St., London, Ontario, Canada N6A 4V2. Address e-mail to webster1{at}julian.uwo.ca

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 III = 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 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.

Implications: 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.

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