Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.04.008
Brazilian Journal of Anesthesiology
Clinical Research

Use of second generation supraglottic airway device for endovascular treatment of unruptured intracranial aneurysms: a retrospective cohort

Uso de dispositivo supraglótico de segunda geração para tratamento endovascular de aneurismas intracranianos não rotos: um estudo coorte retrospectivo

Paola Hurtado, Marta Garcia-Orellana, Sergi Amaro, Enrique Carrero, Federico Zarco, Anna Lopez, Neus Fabregas, Ricard Valero

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Abstract

Background
We aimed to assess the feasibility of using supraglottic devices as an alternative to orotracheal intubation for airway management during anesthesia for endovascular treatment of unruptured intracranial aneurisms in our department over a nine-year period.

Methods
Retrospective single center analysis of cases (2010–2018). Primary outcomes: airway management (supraglottic device repositioning, need for switch to orotracheal intubation, airway complications). Secondary outcomes: aneurysm complexity, history of subarachnoid hemorrhage, hemodynamic monitoring, and perioperative complications.

Results
We included 187 patients in two groups: supraglottic device 130 (69.5%) and orotracheal intubation 57 (30.5%). No adverse incidents were recorded in 97% of the cases. Three supraglottic device patients required supraglottic device repositioning and 1 supraglottic device patient required orotracheal intubation due to inadequate ventilation. Three orotracheal intubation patients had a bronchospasm or laryngospasm during awakening. Forty-five patients (24.1%) had complex aneurysms or a history of subarachnoid hemorrhage. Thirty-three of them (73.3%) required orotracheal intubation compared to 24 of the 142 (16.9%) with non-complex aneurysms. Two patients in each group died during early postoperative recovery. Two in each group also had intraoperative bleeding. A post-hoc analysis showed that orotracheal intubation was used in 55 patients (44%) in 2010 through 2014 and 2 (3.2%) in 2015 through 2018, parallel to a trend toward less invasive blood pressure monitoring from the earlier to the later period from 34 (27.2%) cases to 5 (8.2%).

Conclusion
Supraglottic device, like other less invasiveness protocols, can be considered a feasible alternative airway management approach in selected patients proposed for endovascular treatment of unruptured intracranial aneurisms.

Keywords

Intracranial aneurysm,  Endovascular procedure,  Laryngeal mask,  General anesthesia

Resumo

Introdução: Nosso objetivo foi avaliar a viabilidade do uso de dispositivos supraglóticos como uma alternativa à intubação orotraqueal para o controle das vias aéreas durante a anestesia para o tratamento endovascular de aneurismas intracranianos não rompidos em nosso departamento por um período de nove anos. Metodologia: Análise retrospectiva de casos em um único centro (2010-2018). Desfechos primários: manejo das vias aéreas (reposicionamento do dispositivo supraglótico, necessidade de mudança para intubação orotraqueal, complicações das vias aéreas). Desfechos secundários: complexidade do aneurisma, história de hemorragia subaracnoide, monitoramento hemodinâmico e complicações perioperatórias. Resultados: Foram incluídos 187 pacientes em dois grupos: dispositivo supraglótico 130 (69,5%) e intubação orotraqueal 57 (30,5%). Nenhum incidente adverso foi registrado em 97% dos casos. Três pacientes com dispositivo supraglótico necessitaram de reposicionamento do dispositivo supraglótico e 1 paciente com dispositivo supraglótico precisou de intubação orotraqueal devido à ventilação inadequada. Três pacientes com intubação orotraqueal apresentaram broncoespasmo ou laringoespasmo ao acordar. Quarenta e cinco pacientes (24,1%) apresentavam aneurismas complexos ou história de hemorragia subaracnóidea. Trinta e três deles (73,3%) necessitaram de intubação orotraqueal em comparação com 24 dos 142 (16,9%) com aneurismas não complexos. Dois pacientes em cada grupo morreram durante a recuperação pós-operatória precoce. Dois em cada grupo também tiveram sangramento intra-operatório. Uma análise post-hoc mostrou que a intubação orotraqueal foi usada em 55 pacientes (44%) de 2010 a 2014 e 2 (3,2%) de 2015 a 2018, paralelamente a uma tendência de monitoramento da pressão arterial menos invasivo do período anterior para o posterior (de 34 (27,2%) casos para 5 (8,2%). Conclusão: O dispositivo supraglótico, como outros protocolos menos invasivos, pode ser considerado uma abordagem alternativa viável para o manejo das vias aéreas em pacientes selecionados, propostos para o tratamento endovascular de aneurismas intracranianos não rotos.

Palavras-chave

Aneurisma intracraniano, Procedimento endovascular, Máscara laríngea, anestesia geral

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