2024 FSA Podium and Poster Abstracts
S003: SUPRAGLOTTIC AIRWAYS VERSUS ENDOTRACHEAL INTUBATION FOR CYSTOSCOPY WITH TRANSURETHRAL RESECTION OF BLADDER TUMOR IN OBESE PATIENTS
Brandon To, BS1; Julio A Warren, MD, FASA2; 1University of Central Florida College of Medicine; 2Department of Veterans Affairs Bay Pines FL
Introduction/Background: Supraglottic airways (SGAs) offer an alternative to ventilating patients with facemask or endotracheal tubes (ETTs). Advantages of SGAs over ETTs include ease of use, less airway tissue injury, fewer hemodynamic disturbances, and fewer postoperative complications. However, there is continued debate over its use in obese patients related to poorer pulmonary compliance and ventilation difficulty. Other SGA concerns include aspiration risk and inadequate seal. Cystoscopy with transurethral resection of bladder tumor (cysto-TURBT) is a surgery in the lithotomy position with possible concern over gastric content aspiration with an SGA. This study aims to examine safety and perioperative outcomes of SGAs versus ETTs in obese patients undergoing cysto-TURBT compared to non-obese patients.
Methods: This is a retrospective chart review including 135 cysto-TURBT cases requiring airway management at the Department of Veterans Affairs in Bay Pines, FL, from fiscal year 2019-2022. The sample was divided into 4 groups: 36.3% SGA non-obese patients, 33.3% ETT non-obese, 14.8% SGA obese, and 15.6% ETT obese patients. Intraoperative and total perioperative opioid dosages, post-anesthesia care unit (PACU) complications, and PACU recovery time were recorded. Opioid dosages were converted to morphine milligram equivalents (MMEs) using the Johns Hopkins equianalgesic chart. The 4 groups’ perioperative and intraoperative MMEs as well as PACU recovery time were compared employing Kruskal-Wallis H tests using SPSS28.0.
Results: There were no statistically significant differences in intraoperative MMEs (p=.379), total perioperative MMEs (p=.806), and PACU recovery time (p=.384) between airway type and obesity groups. PACU complications associated with ETTs included cough (n=1, 1.5%), surgical site pain (n=7, 10.6%), and hypertension (n=3, 4.5%). SGA-associated complications included surgical site pain (n=1, 1.4%) and hypotension (n=2, 2.9%). Chi-Square test revealed differences in surgical site pain when comparing SGAs to ETTs (p=.024). There were two cases, both with body-mass index of 29.3, in which SGAs were initially used but provided inadequate seal, leading to ETT usage. One of those cases was associated with post-operative cough.
Figure 1. Comparison of Opioid Dosage between Airway Types Stratified by Obesity
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Figure 2. Comparison of PACU Recovery Time between Airway Types Stratified by Obesity
Discussion/Conclusion: This study demonstrates that both SGAs and ETTs may be used in obese patients undergoing cysto-TURBT with similar efficacy and safety profiles. There was only one airway specific PACU complication (cough), which likely resulted from tissue trauma due to multiple device placement attempts. Other findings included greater incidence of surgical site pain and hypertension with ETTs, and findings of hypotension with SGAs. Although existing literature suggests lower opioid dosages and lengths of stay for SGAs compared to ETTs, no significant differences were found in this study. This study suggests possible under-utilization of opioids in the ETT cases, but other confounding factors may have contributed to post-operative pain. Strengths of this study include an even distribution of cases of SGAs vs ETTs in both the non-obese and obese subsets. Small sample size is a limitation. Further investigation should be conducted to examine the safety and efficacy of SGA use in obese patients undergoing other surgical procedures.