Pulmonary complications following postpartum tubal ligation with laryngeal mask vs. endotracheal intubation: a retrospective cohort study (2012–2024)

Background

General anesthesia with endotracheal intubation is standard in obstetric patients due to the risk of aspiration. However, endotracheal intubation carries procedure-related risks, prompting interest in laryngeal masks as alternative or rescue devices. Evidence supporting their use in postpartum tubal ligation remains limited.

Methods

A retrospective cohort study was conducted at a high-risk obstetric center, including patients who underwent postpartum tubal ligation between 2012 and 2024. Patients were grouped according to the airway device used: laryngeal mask or endotracheal intubation, including those who required conversion. The primary outcome was the incidence of respiratory complications, including pneumonia, respiratory failure, anesthesia-related reactions, and other significant adverse events, within seven postoperative days. Secondary analyses included demographic and obstetric characteristics.

Results

There were 1,095 cases performed under general anesthesia, 503 (46 %) received endotracheal intubation and 592 (54 %) supra-glottic airway. No respiratory complications were observed in either group; Poisson-based confidence intervals confirmed that the upper bound of incidence remained < 1 %. Patients with supra-glottic airway were more likely to be ASA I (34 % vs. 21 %), and 2.6 % had conversion to endotracheal intubation. Patients with endotracheal intubation had a higher median body mass index (29.7 vs. 29.2 kg/m², P = 0.027).

Conclusion

In this retrospective analysis of postpartum tubal ligation under general anesthesia, there were no respiratory complications with either airway device. Supraglottic airway devices appear to be a safe alternative in carefully selected patients.