Benefit of Gastro™ Laryngeal Mask Airway® during Total Intravenous Anesthesia for Endoscopic Retrograde Cholangiopancreatography: A Randomized Controlled Study.

Abstract

Context: Deep level of sedation required during endoscopic retrograde cholangiopancreatography (ERCP) can cause hypoxia in part due to an unsecured airway. This study aims to study the benefits of using the laryngeal mask airway (LMA) Gastro to secure the airway in ERCP.

Aims: To determine the benefit of Gastro LMA for securing airway for ERCP procedure, by recording the incidence of intraprocedural adverse cardiorespiratory events - hypoxia, hypotension, bradycardia, and arrhythmias.

Settings and design: A prospective randomized controlled study was conducted at a tertiary hospital with the American Society of Anesthesiologists (ASA) Grade I to III patients undergoing ERCP procedure in the endoscopy suite.

Subjects and methods: Eighty patients between 18 and 70 years of age fulfilling the inclusion criteria undergoing ERCP were selected for this prospective, randomized controlled study, after obtaining institutional ethical committee approval. Patients were allocated to either LMA Gastro group (G) or to control group (C). Standard anesthesia protocols were followed, and cardiorespiratory parameters were recorded at regular intervals during the course of the procedure.

Statistical analysis used: Comparisons were made using t-tests and Chi-square tests, with significance set at P < 0.05.

Results: Our study demonstrated that the LMA Gastro group maintained significantly greater oxygen saturation, with nil hypoxic events occurring in this group. Comparatively, the control group experienced four episodes of hypoxia. The LMA Gastro group also demonstrated statistically significant increases in mean blood pressure, while mean heart rates were lower. However, these did not translate to any clinically significant differences, and the incidence of hypotension and bradycardia events were comparable between the groups. The total amount of propofol required to maintain desired sedation levels was found to be comparable between the groups. No postoperative hemodynamic or respiratory adverse events were recorded, and incidence of sore throat was found to be statistically insignificant.

Conclusions: The LMA Gastro offers excellent control of the patient airway during TIVA for ERCP, providing superior maintenance of oxygen saturation. It also allows for the initiation of positive pressure ventilation when required. The hemodynamic profile including incidence of hypotension and arrhythmias, while providing sedation with the LMA Gastro in situ is not clinically significant in comparison to sedation with native unsecured airway. It can be easily inserted by an anesthetist, and it offers the same level of efficacy and safety even in ASA class III patients. These characteristics make it an attractive primary airway technique in ERCP.