Comparative study of laryngeal mask airway and tracheal tube in total knee arthroplasty in elderly patients

Yan Lei; Shi Wenjian; Xu Guiping

doi:10.3760/cma.j.issn.1673-4777.2016.06.021

Abstract：Objective To compare the the efficacy and safety of laryngeal mask airway and tracheal tube in total knee arthroplasty (TKA) in elderly patients.Methods Sixty elderly patients undergoing TKA from April 2014 to May 2015 were randomly divided into tracheal tube group (ETT group,30 cases) and laryngeal mask airway group (LMA group,30 cases).ETT group and LMA group were induced with propofol 1.5 mg/kg and fentanyl 3 μg/kg through endotracheal tube and laryngeal mask airway respectively,and ETT group was additionally given vecuronium 0.1 mg/kg;the resPiratory parameters was adjusted according to the end-tidal carbon dioxide partial pressure;2％-3％ sevoflurane inhalation and intravenous infusion of propofol were given in maintenance of anesthesia,fentanyl and veeuronium were added according to need.The number of intubation or LMA insertion,intraoperative and postoperative adverse reaction were recorded;the heart rate (HR),systolic blood pressure (SBP),pulse oxygen saturation (SpO2) before intubation or LMA insertion (T0),immediately after intubation (T1),1 and 5 min after intubation or LMA insertion (T2,T3),extubation (T4) were compared between groups;the duration time from beginning of surgery to extubation,the time of leaving postanesthesia care unit (PACU) were compared between groups.Results One patient in LMA group LMA insertion was failed in 1 patients due to the large tonsils and turned into EET group,whose results were excluded from LMA group.The one time success rate of intubation or LMA insertion was not significantly different between EET group and LMA group [96.7％ (29/30) vs 90.0％ (27/30)] (P＞0.05).The incidence of adverse reaction in LMA group was significantly lower than that in ETT group [24.1％ (7/29) vs 63.3％ (19/30)] (P ＜ 0.05).The HR was significantly lower in LMA group than that in ETT group at T1,T2,T3,T4 [(84 ± 14) times/min vs (89 ± 17) times/rin,(71±14) times/min vs (76 ±10) times/min,(70 ±10) times/min vs (74 ±9) times/min,(77 ± 13) times/min vs (82 ± 9) times/min] (P ＜ 0.05).The SBP in LMA group was significantly lower than that in ETT group at T1,T2,T4 [(81 ± 12) mmHg vs (87 ± 12) mmHg,(74 ± 12) mmHg vs (80 ± 12) mmHg,(81 ± 9) mmHg vs (83 ± 11) mmHg] (P ＜ 0.05).The SpO2 was not significantly different between groups at all time points (P ＞ 0.05).The duration time from beginning of surgery to extubation,the time of leaving (PACU) were significantly shorter in LMA group than those in EET group [(20 ± 19) min vs (32 ± 22) min,(39 ± 22) min vs (65 ± 25) min] (P ＜ 0.05).Conclusion Laryngeal mask airway anesthesia is safe and effective in TKA in elderly patients,which can be a substitute for endotracheal intubation anesthesia.