Shan Jiang, Fei Yin, Mei-qing Wang, Yan Cui, Yang Sun#
Department of Anesthesiology, Nanjing Chest Hospital, Nanjing Brain Hosptial Affiliated to Nanjing Medical University,Nanjing, 210029, China
Background and objective: Pulmonary bullae can be resected via non-intubated uniportal video-assisted thoracoscopic surgery with a laryngeal mask airway (LMA). I-gel is a novel LMA that avoids invasion of the airway. This study compared the feasibility and safety of I-gel with the classic laryngeal mask airway (cLMA) in non-intubated uniportal thoracoscopic resection of pulmonary bullae.
Methods: Forty consecutive patients who underwent non-intubated uniportal thoracoscopic resection of pulmonary bullae were included in this prospective study. They were randomized into two equal groups: I-gel group (Group I) and classic LMA group(Group C). All patients received general anesthesia without muscle relaxants, allowing spontaneous breathing. I-gel or classic LMA of appropriate size for patients’ weight was inserted. The time required for insertion, success rates of first insertion attempt, airway-leak pressure, and complications were recorded for each patient.
Results: The time required for insertion was significantly less for Group I patients (15.6 ± 4.9 s) than for Group C patients (27.3±12.6 s) (P=0.016). The success rate for first insertion attempt was significantly higher for Group I patients (16/20) than for Group C patients (4/20) (P=0.025). Airway-leak pressure was significantly higher for Group I patients (26.6±5.1 cm H2O) than for Group C patients (18.2±16.2 cm H2O) (0.023). The incidence of operative complication (blood-tinged airway) and postoperative complication (sore throat) was higher for group C patients than for group I patients (P=0.015 and P=0.021, respectively).
Conclusion: I-gel is superior to classic LMA in several criteria for non-intubated uniportal thoracoscopic resection of pulmonary bullae under spontaneous breathing general anesthesia.
I-gel, spontaneous breathing anesthesia, uniportal thoracoscopy, pulmonary bullae resection, thoracoscopy.