Key result
Supreme laryngeal mask airway demonstrated a similar first-attempt insertion success rate compared to endotracheal intubation (99.1% vs 99.1%, OR 1.00) during general anesthesia for cesarean section.
Why the study?
Endotracheal intubation is the standard of care for obstetric airway management, but the laryngeal mask airway has gained acceptance as a rescue airway in guidelines.
Does the Supreme laryngeal mask airway improve first-attempt insertion success compared to endotracheal intubation in parturients undergoing elective cesarean section under general anesthesia?
RCT (n=920)
Single-blind
Randomized into 2 groups with allocation concealed using sealed opaque envelopes
No
Does the Supreme laryngeal mask airway improve first-attempt insertion success compared to endotracheal intubation in parturients undergoing elective cesarean section under general anesthesia?
Odds Ratio: 1 (95% CI 0.25–4.02)
Absolute Event Rate: 99.1% vs 99.1%
p-value: p=1.0000
The Supreme laryngeal mask airway provides similar first-attempt insertion success but significantly faster time to effective ventilation compared to endotracheal intubation in low-risk parturients undergoing elective cesarean section.
Supports Supreme LMA as noninferior alternative to endotracheal intubation in cesarean GA; extends randomized evidence for supraglottic airways in obstetrics.
Background The obstetric airway is a significant cause of maternal morbidity and mortality. Endotracheal intubation is considered the standard of care but the laryngeal mask airway (LMA) has gained acceptance as a rescue airway and has been incorporated into the obstetric airway management guidelines. In this randomized controlled equivalence trial, we compared the Supreme LMA (SLMA) with endotracheal intubation (ETT) in managing the obstetric airway during cesarean section. Methods Parturients who underwent elective cesarean section under general anesthesia were randomized to receive either an SLMA or ETT as their airway device. Our primary outcome was first-attempt insertion success. Successful insertion was defined as adequate bilateral air entry with auscultation and the presence of end-tidal carbon dioxide on the capnogram. The first-attempt insertion success rate was compared using the Chi-Square test. Secondary outcomes included time-to-ventilation, seal pressure, ventilation/hemodynamic parameters, occurrence of clinical aspiration, foetal outcomes, and maternal side effects associated with the airway device. Results We recruited 920 parturients (460 SLMA, 460 ETT) who underwent elective Caesarean section under general anesthesia. Patient characteristics were similar between the groups. First attempt success was similar (Odds Ratio--ORSLMA/ETA: 1.00 (95%CI: 0.25, 4.02), p = 1.0000). SLMA was associated with reduced time to effective ventilation (Mean Difference--MD -22.96; 95%CI: -23.71, -22.21 seconds) compared to ETT group (p<0.0001). Ventilation parameters, maternal and fetal outcomes were similar between the groups, and there was no aspiration. Conclusions SLMA could be an alternative airway management technique for a carefully selected low-risk obstetric population, with similar insertion success rates, reduced time to ventilation and less hemodynamic changes compared with ETT. Our findings are consistent with the airway guidelines in recommending the second line use of LMA in the management of obstetric airway.
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Yao et al. (2019) conducted an RCT in Cesarean section under general anesthesia (n=920). Supreme laryngeal mask airway (SLMA) vs. Endotracheal intubation (ETT) was evaluated on First-attempt insertion success (OR 1.00, 95% CI 0.25, 4.02, p=1.0000). Supreme laryngeal mask airway demonstrated a similar first-attempt insertion success rate compared to endotracheal intubation (99.1% vs 99.1%, OR 1.00) during general anesthesia for cesarean section.
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