Laryngeal mask airway facilitates safe and smooth emergence from anesthesia following craniotomy

1. In patients undergoing craniotomy, a laryngeal mask airway following extubation facilitated a safer and smoother emergence from anesthesia than those undergoing deep extubation.

Evidence Rating Level: 1 (Excellent)

In patients undergoing craniotomy, coughing following anesthesia can cause significant cardiorespiratory consequences such as laryngospasm, upper airway obstructions, and tachycardia. It is essential that appropriate anesthetics and intubation modalities are employed to reduce adverse effects within this population to ensure a smooth emergence from anesthesia post-surgery. Studies have suggested that the insertion of a laryngeal mask airway (LMA) following endotracheal extubation can contribute to a smoother emergence from anesthesia, which is known as the Bailey Maneuver. As such, this randomized controlled trial aimed to investigate whether Bailey Maneuver compared to standard extubation methods led to a safer and smoother emergence from anesthesia among patients undergoing craniotomy. This study included 62 adult participants without anticipated difficult airways and difficult LMA use, and with no prior contraindications to intubating an LMA. All participants had a three-minute pre-oxygenation period with similar inductions of anesthesia with fentanyl, propofol, and rocuronium. Oral intubation was performed, and anesthesia was maintained using sevoflurane. Participants were randomly assigned to either the deep extubation group or the LMA group, where the endotracheal tube was replaced by the LMA according to the Bailey Maneuver. The primary outcomes of this study included oxygen and carbon dioxide changes, as well as respiratory complications and hemodynamic changes. Respiratory complications included coughs, snores, oxygen desaturations, aspirations, and bronchospasms. This study showed that respiratory complications such as coughs and snores occurred more frequently in the deep extubation group. As well, more participants in the deep extubation group required more airway maneuvers such as a nasal airway or chin lifting. In conclusion, this study shows that early and smooth endotracheal extubation can be achieved by adhering to the Bailey Maneuver for patients undergoing craniotomy. Further research regarding the use of Bailey Maneuver among different population groups and multicenter sites can determine its application to clinical practice broadly.

Click to read the study in BMC Anesthesiology

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