COMPARISON OF THE ENDOTRACHEAL TUBE AND LANRYNGEAL MASK ARIWAY IN DIFFICULT AIRWAY MANAGEMENT
Article Sidebar
Main Article Content
Abstract
Background: Effective airway management remains a cornerstone of emergency and surgical care, especially in patients with anticipated or unanticipated difficult airways. The choice of device can significantly impact patient outcomes. Among the available options, the endotracheal tube (ETT) and laryngeal mask airway (LMA) are widely used. However, the clinical superiority of one over the other in difficult airway scenarios continues to be a topic of ongoing investigation, particularly in resource-constrained or emergency settings.
Objective: To compare the effectiveness of ETT and LMA in managing difficult airways in terms of insertion time, success rate, and complication frequency.
Methods: A cross-sectional study was conducted over six months across three tertiary hospitals, enrolling 130 adult patients aged 18 years and above who required general anesthesia and met the criteria for difficult intubation. Patients were allocated to receive either an ETT or LMA based on the attending anesthesiologist’s clinical judgment. Insertion time was recorded in seconds, and any complications such as sore throat, airway trauma, or laryngospasm were documented. Data were analyzed using IBM SPSS Version 29. An independent t-test and chi-square test were applied to determine statistical significance, with p < 0.05 considered significant.
Results: The mean insertion time for LMA was significantly shorter at 54.3 seconds compared to 183.6 seconds for ETT (p < 0.001). The first-attempt success rate was higher for LMA (84.6%) than ETT (30.8%) (p < 0.001). Complications were notably fewer with LMA (23.1%) than with ETT (53.8%) (p = 0.002), suggesting improved safety and ease of use with LMA in difficult airway cases.
Conclusion: LMA proved to be a faster, safer, and more effective option compared to ETT in the management of difficult airways, especially in scenarios demanding rapid airway control. Further large-scale studies are recommended for broader validation.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Sanders JE, Spina LA. Supraglottic airway devices for pediatric airway management in the emergency department. Pediatr Emerg Med Pract. 2020;17(10):1-20.
O'Shea JE, Scrivens A, Edwards G, Roehr CC. Safe emergency neonatal airway management: current challenges and potential approaches. Arch Dis Child Fetal Neonatal Ed. 2022;107(3):236-41.
Eguia A, Jiang ZY, Brollier L, Matuszczak M, Yuksel S, Roy S, et al. Reducing intraoperative time with laryngeal mask airway and stretcher in pediatric adenotonsillectomy. Am J Otolaryngol. 2022;43(1):103195.
Lee DH, Stang J, Reardon RF, Martel ML, Driver BE, Braude DA. Rapid Sequence Airway with the Intubating Laryngeal Mask in the Emergency Department. J Emerg Med. 2021;61(5):550-7.
Pejovic NJ, Myrnerts Höök S, Byamugisha J, Alfvén T, Lubulwa C, Cavallin F, et al. A Randomized Trial of Laryngeal Mask Airway in Neonatal Resuscitation. N Engl J Med. 2020;383(22):2138-47.
Mani S, Rawat M. Proficiency of Laryngeal Mask Airway Insertion Skill in NRP Certified Providers. Am J Perinatol. 2022;39(9):1008-14.
Zheng J, Du L, Wang J, Zhang L, Chen G. Prewarming i-gel laryngeal mask for mechanical ventilation: a meta-analysis of randomised control trials and trial sequential analysis. BMJ Open. 2021;11(8):e045461.
Ni Chathasaigh CM, Davis PG, O'Donnell CP, McCarthy LK. Nasal interfaces for neonatal resuscitation. Cochrane Database Syst Rev. 2023;10(10):Cd009102.
Diggikar S, Krishnegowda R, Nagesh KN, Lakshminrusimha S, Trevisanuto D. Laryngeal mask airway versus face mask ventilation or intubation for neonatal resuscitation in low-and-middle-income countries: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2023;108(2):156-63.
Trevisanuto D, Gizzi C, Cavallin F, Beke A, Buonocore G, Charitou A, et al. Laryngeal Mask Airway in Neonatal Resuscitation: A Survey of the Union of European Neonatal and Perinatal Societies. Neonatology. 2024;121(6):780-90.
Shah BA, Blunt M, Kassa N, Dannaway D. Laryngeal Mask Airway (LMA) Placement in a Neonatal Patient Simulator Using a Non-Inflatable Supraglottic Airway (SGA). J Vis Exp. 2023(197).
Markham T, AlFarra AS, Tejani M, Tate DJ, Barrera JE, Paladugu S, et al. Effectiveness of Ventilation via an Endotracheal Tube in Pharynx Versus a Facemask in Patients With Potentially Difficult Airway: A Randomized, Crossover, and Blind Trial. Anesth Analg. 2025;140(2):280-9.
Dundar ZD, Ayranci MK, Kocak S, Girisgin AS. Bag-Valve-Mask versus Laryngeal Mask Airway Ventilation in Cardiopulmonary Resuscitation with Continuous Compressions: A Simulation Study. Prehosp Disaster Med. 2021;36(2):189-94.
Mangahas AM, Talugula S, Husain IA. Anesthesia considerations during management of airway stenosis: A systematic review. Am J Otolaryngol. 2023;44(2):103767.
Seet E, Nagappa M, Wong DT. Airway Management in Surgical Patients With Obstructive Sleep Apnea. Anesth Analg. 2021;132(5):1321-7.
Apfelbaum JL, Hagberg CA, Connis RT, Abdelmalak BB, Agarkar M, Dutton RP, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136(1):31–81.
Sukhsaraj AJ. Airway management in the difficult airway patient: A comparison of ETT and LMA devices. Int J Emerg Med. 2020;13(1):20-22.
Leister N, Heindl LM, Rokohl AC, Böttiger BW, Menzel C, Ulrichs C, Schick VC. Laryngeal Mask Airway Versus Endotracheal Intubation during Lacrimal Duct Stenosis Surgery in Children—A Retrospective Analysis. Children. 2024 Mar 7;11(3):320.
Hammer M, Santer P, Schaefer MS, Althoff FC, Wongtangman K, Frey UH, Xu X, Eikermann M, Fassbender P. Supraglottic airway device versus tracheal intubation and the risk of emergent postoperative intubation after general anaesthesia in adults: a retrospective cohort study. British Journal of Anaesthesia. 2021 Mar 1;126(3):738-45.
Dong W, Zhang W, Er J, Liu J, Han J. Comparison of laryngeal mask airway and endotracheal tube in general anesthesia in children. Experimental and Therapeutic Medicine. 2023 Dec 1;26(6):1-8.
Dong W, Zhang W, Er J, Liu J, Han J. Comparison of laryngeal mask airway and endotracheal tube in general anesthesia in children. Experimental and Therapeutic Medicine. 2023 Dec 1;26(6):1-8.
Driver BE, Martel M, Lai T, Marko TA, Reardon RF. Use of the intubating laryngeal mask airway in the emergency department: A ten-year retrospective review. The American Journal of Emergency Medicine. 2020 Jul 1;38(7):1367-72.