Laryngeal Mask Airway for Cesarean Delivery: A 5-Year Retrospective Cohort Study.

Chin Med J (Engl)

Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China.

Published: February 2017

AI Article Synopsis

  • The study examined the use of the laryngeal mask airway (LMA) in women undergoing cesarean deliveries at Peking University First Hospital over a 5-year period, focusing on its effectiveness and safety compared to endotracheal intubation (ET).
  • Out of 192 general anesthesia cases for cesarean delivery, 68.9% used ET and 31.1% used LMA; no instances of regurgitation or aspiration were reported in either group.
  • While the LMA showed potential for use in obstetric anesthesia, further research is needed to determine if it can consistently replace endotracheal intubation in routine practice.

Article Abstract

Background: The laryngeal mask airway (LMA) is the most commonly used rescue airway in obstetric anesthesia. The aim of this retrospective cohort study was to evaluate the application of the LMA in parturients undergoing cesarean delivery (CD) for 5 years in our hospital. As a secondary objective, we investigated the incidence of airway-related complication in obstetric general anesthesia (GA).

Methods: We collected electronic data for all obstetric patients who received GA for CD between January 2010 and December 2014 in Peking University First Hospital. Based on the different types of airway device, patients were divided into endotracheal intubation (ET) group and LMA group. The incidences of regurgitation and aspiration, as well as maternal and neonatal postoperative outcomes were compared between groups.

Results: During the 5-year study, GA was performed in 192 cases, which accounted for 2.0% of all CDs. The main indications for GA were contraindication to neuraxial anesthesia or a failed block. Among these, ET tube was used in 124 cases (68.9%) and LMA in 56 cases (31.1%). The percentage of critical patients above the American Society of Anesthesiologists' Grade II was 24/124 in ET group and 4/56 in LMA group (P = 0.036). The emergent delivery rate was 63.7% for ET group and 37.5% for LMA group (P = 0.001). None of the patients had regurgitation or aspiration. There were no significant differences in terms of neonatal Apgar scores, maternal and neonatal postoperative outcomes between the two groups.

Conclusions: Our results suggested that GA was mainly used for contraindication to neuraxial anesthesia or a failed block, and emergent CDs accounted for most cases. The second-generation LMA could be used for obstetric anesthesia, but correct position to achieve a good seal is the key to prevent reflux and aspiration. Whether they could replace the tracheal tube in routine practice needs further large prospective studies.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324375PMC
http://dx.doi.org/10.4103/0366-6999.199833DOI Listing

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