Can Laryngeal Mask Airway be the First Choice for Tracheal Stenosis Surgery? A Historical Cohort Study

A irway management during tracheal surgeries is chal- lenging due to the impaired airway anatomy and the need to share the trachea with the surgical team.[1] To maintain oxygenation during tracheal surgery, anesthesiologists may utilize various techniques, including tracheal intubation, application of laryngeal mask airway (LMA), jet ventila-tion, and extracorporeal membranous oxygenation (ECMO).For tracheal reconstruction surgeries, ventilation is divided specifically into three stages: pre-tracheal resection, anastomosis, and post-anastomosis.[2] When conventional orotracheal intubation (OTI) is applied, maneuvers such as withdrawal of the tube at the resection stage, advancingObjectives: To compare the usage of laryngeal mask airway (LMA) and orotracheal intubation (OTI), which are separate airway management methods in tracheal reconstruction surgeries, in terms of perioperative management, mortality, and morbidity.Methods: Adult patients who underwent tracheal reconstruction surgery between June 2020 and June 2022 were included in the study, retrospectively.Patients with lost data or primary tracheal malignancy were excluded.Patients who underwent tracheal reconstruction were divided into two groups: LMA and OTI.Results: Of a total of 57 included patients, the OTI and LMA groups had 30 (52.63%) and 27 patients (47.37%), respectively.The rate of intubated transfer to the intensive care unit and the length of stay in the intensive care unit were significantly higher in the OTI group (p=0.014, p=0.031) than those of the LMA group; further, in tracheal cultures, reproduction was also significantly higher in the OTI group (23.33%) (p=0.007).The postoperative mortality rates were similar in both groups.Conclusion: Since the absence of tension in end-to-end anastomosis of the trachea is vital for successful surgery, the LMA application (which has no tracheal contact) can be considered superior to OTI.In this study, LMA was successfully applied in all patients.Considering that the aim of anesthesia management should be to provide adequate oxygenation and normocarbia with minimally invasive intervention, we suggest airway management using LMA as the first option for tracheal reconstruction surgery because of the advantages described in this study.