Second generation laryngeal mask airway during laparoscopic living liver donor hepatectomy: a randomized controlled trial

The second-generation laryngeal mask airway (LMA) provides a higher sealing pressure than classical LMA and can insert the gastric drainage tube. We investigated the difference in respiratory variables according to the use of second-generation LMA and endotracheal tube (ETT) in laparoscopic living liver donor hepatectomy (LLDH). In this single-blind randomized controlled trial, intraoperative arterial carbon dioxide partial pressure at 2 h after the airway devices insertion (P(a)CO(2_)2h) was compared as a primary outcome. Participants were randomly assigned to the following groups: Group LMA (n=45, used Protector LMA), or Group ETT (n=43, used cuffed ETT). Intraoperative hemodynamic and respiratory variables including mean blood pressure (MBP), heart rate (HR), and peak inspiratory pressure (PIP) were compared. Postoperative sore throat, hoarseness, postoperative nausea and vomiting (PONV), and pulmonary aspiration were recorded. The P(a)CO(2_)2h were equally effective between two groups (mean difference: 0.99 mmHg, P=0.003; 90% confidence limits:-0.22, 2.19). The intraoperative change in MBP, HR, and PIP were differed over time between two groups (P<0.001, P=0.015, and P=0.039, respectively). There were no differences of the incidence of postoperative complications at 24 h following LLDH (sore throat and hoarseness: P>0.99, PONV: P>0.99, and P=0.65, respectively). No case showed pulmonary aspiration in both groups. Compared with endotracheal tube, second-generation LMA is equally efficient during LLDH. The second-generation LMA can be considered as the effective airway devices for securing airway in patients undergoing prolonged laparoscopic surgery. Trial Registration This study was registered at the Clinical Trial Registry of Korea (https://cris.nih.go.kr. CRiS No. KCT0003711).

Automated summary

The study found that the second-generation laryngeal mask airway (LMA) is equally effective as an endotracheal tube (ETT) in laparoscopic living liver donor hepatectomy (LLDH), with some differences in intraoperative physiological variables, but similar rates of postoperative complications.