Superior recovery and efficiency with laryngeal mask airway compared to endotracheal intubation in minimally invasive repair of pectus excavatum: a retrospective analysis

Background Minimally invasive repair is the standard treatment for patients with pectus excavatum. Recent data suggest that using a laryngeal mask airway during thoracic surgery might offer advantages over endotracheal intubation, such as faster recovery from surgery, shorter anesthesia times and fewer complications. The aim of this study was to evaluate the safety and potential benefits of laryngeal mask airway use in minimally invasive pectus excavatum repair. Methods Retrospective analysis of electronic anesthesia protocols and records of patients who underwent pectus excavatum repair at a large academic center between 2019 and 2024. Perioperative data, complications, and procedural times were evaluated. Patients who had their airways secured with endotracheal intubation were compared to those who were ventilated using a laryngeal mask. Results Data of 48 patients were analyzed ( n = 32 with endotracheal intubation, n = 16 for laryngeal mask). The use of a laryngeal mask significantly shortened anesthesia induction time (4.0 vs. 7.5 min, p = 0.002), recovery time (9.1 vs. 19.0 min, p = 0.002) and emergence time (7.0 vs. 17.0 min, p < 0.001). Patients in the laryngeal mask group also had a significantly reduced need for postoperative oxygen supplementation (6.3 vs. 36.8%, p = 0.008). There were fewer anesthesiologic complications when a laryngeal mask was used, although this difference did not reach statistical significance (6.3 vs. 18.5%, p = 0.65). Hospital (6 vs. 5.5 days, p = 0.81) and ICU length of stay (21.73 vs. 23.84 h, p = 0.31), surgical complications (18.8 vs. 15.6%, p = 0.79) and incision-suture time (90.3 vs. 89.7 min, p = 0.92) were comparable in both groups. Conclusions The use of a laryngeal mask in minimally invasive pectus excavatum repair is safe and effective. Its advantages— reduced respiratory complications and shorter anesthesia-related times—support its use as an alternative airway device for this procedure for medical as well as for economic reasons.