Authors:	Kriege, Marc Rissel, René Heid, Florian Ott, Thomas El Beyrouti, Hazem Hotz, Eric
Title:	Airway management with novel intubating laryngeal tubes has no influence on cerebral oxygenation in cardiac surgery patients: a prospective observational study
Online publication date:	24-Jan-2023
Year of first publication:	2022
Language:	english
Abstract:	Background: A laryngeal tube is often used as an alternative to intubation with direct laryngoscopy during cardiopulmonary resuscitation. However, in a study with piglets undergoing simulated cardiac arrest, reduced carotid artery blood flow was associated with the insertion of different supraglottic airway devices, such as a laryngeal tube. Limited by its construction, secondary tracheal intubation through a laryngeal tube was difficult or impossible in contrast to a second generation laryngeal mask. The new disposable intubating laryngeal tube with suction (iLTS-D®) seems to facilitate tracheal intubation. We hypothesized that iLTS-D, when inflated to the recommended air volume, does not reduce cerebral oxygenation in patients with cardiovascular diseases undergoing elective cardiac surgery. Methods: This single-center prospective, controlled observational study was approved by the local ethics committee (Ethical Committee No. 2018-13716). Forty adult patients undergoing elective cardiac surgery requiring tracheal intubation were included in this study. The exclusion criteria were age <18 years and a high risk of aspiration, inability to consent, height <155 cm, or pregnancy. Prior to insufflation and deflation of the cuffs, we performed cerebral oximetry via near-infrared spectroscopy. The primary outcome was a significant reduction in NIRS in the context of the preinduction baseline value after inflation of the cuffs with the recommended air volume, defined as a ≥25% decrease from baseline or an absolute value ≤ 50%. The secondary endpoints were differences in time points, insertion success rates, and complications. Results: There was no significant reduction in cerebral oximetry after inflation with the recommended cuff volume and an initially measured cuff pressure of >120 cmH2O. Overall, tracheal intubation was achieved in a median of 20 s [interquartile range 15-23 s] and enabled sufficient ventilation and tracheal intubation through the iLTS-D in all patients. Traces of blood on the cuffs (after removing the iLTS-D) and a sore throat (evaluated 2 h after removing the tracheal tube) were observed in one patient. Conclusion: Our results showed no association between the insertion of the iLTS-D and reduced cerebral oxygenation in patients undergoing elective cardiac surgery.
DDC:	610 Medizin 610 Medical sciences
Institution:	Johannes Gutenberg-Universität Mainz
Department:	FB 04 Medizin
Place:	Mainz
ROR:	https://ror.org/023b0x485
DOI:	http://doi.org/10.25358/openscience-8615
Version:	Published version
Publication type:	Zeitschriftenaufsatz
Document type specification:	Scientific article
License:	CC BY
Information on rights of use:	https://creativecommons.org/licenses/by/4.0/
Journal:	Frontiers in anesthesiology 1
Pages or article number:	990391
Publisher:	Frontiers
Publisher place:	Lausanne
Issue date:	2022
ISSN:	2813-480X
Publisher DOI:	10.3389/fanes.2022.990391
Appears in collections:	DFG-491381577-G