Eignung der Larynxmaske im Vergleich zur endotrachealen Intubation für die Atemwegssicherung - Ein prospektiver randomisierter doppelblinder Vergleich hinsichtlich laryngealer Schädigungen und Stimmveränderungen

The endotracheal tube and the laryngeal mask are common methods for securing airways in general anesthesia. Both airway devices are basically suitable for most patients and for a wide range of surgical procedures. However, due to the continuously expanding range of indications for the newer generations of laryngeal masks and the frequently postulated lower risk of postoperative complications originating from supraglottic airway devices, the laryngeal mask is increasingly competing with the endotracheal tube. The aim of the present prospective randomized study was to compare the two airway devices, the endotracheal tube and the laryngeal mask, regarding the occurrence of postoperative voice disorders, subjective discomfort and objective laryngeal injuries. A total of 139 patients were included, 65 thereof received an endotracheal tube, 74 a laryngeal mask. Subjective complaints were gathered pre- and postoperatively with questionnaires. Larynx and the vocal folds were examined by stroboscopy before and after airway device application. The degree of injury was used for the status assessment. In addition, the voice of the patients was recorded pre- and postoperatively and evaluated with the RBH scale. When the two airway devices were compared, significantly more laryngeal injuries were found in the glottic and subglottic area after use of an endotracheal tube. Hoarseness was also significantly more complained about after use of an endotracheal tube than laryngeal mask, based on the As-treated-analysis outcome. Voice analysis according to the RBH scheme showed no significant differences between the two airway devices for any of the hoarseness criteria (roughness, breathy, hoarseness). Only one optional parameter of the VHI-12-questionnaire showed a significantly more severe voice disorder according to endotracheal intubation, while no differences regarding the VHI-12-index could be shown. A clear statement regarding the clinical relevance cannot be made based on these results. In summary, this AWS-study was able to show that the use of a laryngeal mask can offer an advantage over the use of an endotracheal tube, as the laryngeal injury rate is lower. The laryngeal mask also appears to be superior to the endotracheal tube regarding the occurrence of postoperative hoarseness. Voice disorders caused by the use of different airway devices should be further investigated in future studies.