A comparative evaluation of LMA® Gastro™ versus Gastro Laryngeal Tube for airway management in patients undergoing endoscopic retrograde cholangiopancreatography under general anesthesia: A randomized control study

Background: Endoscopic Retrograde Cholangio-Pancreatography is fraught with anesthetic challenges. Various anesthesia techniques have been studied, ranging from sedation to general anesthesia with tracheal intubation or specialized supra-glottic airway devices. Methods: This randomized control trial included 70 patients undergoing endoscopic retrograde cholangio-pancreatography under general anesthesia and divided equally into two groups, LMA (R) Gastro (TM) or Gastro-Laryngeal tube. The primary objective was to compare the 1st time success rate and the secondary outcomes included, ease of insertion, number of attempts, oropharyngeal leak pressure, occurrence of adverse events; hemodynamic and ventilatory parameters. They were also compared in terms gastroenterologist's feedback about the device. Results: The first-time success rate for LMA (R) Gastro (TM) group was 88.5% and for Gastro-Laryngeal tube group was 77.1% (p value = 0.10). The mean difference for ease of insertion (p value = 0.001), oropharyngeal leak pressure (p value < 0.0001), peak airway pressure (p value < 0.0001) at different time intervals were significant for LMA (R) Gastro (TM) group. Hemodynamic response in terms of mean arterial pressure at 0 min (p value = 0.021) and gastroenterologist's feedback (p value < 0.0001) for Gastro-Laryngeal tube group was shown to be statistically significant. The mean difference between two groups for number of attempts, complications, hemodynamic response, end tidal volume, EtCO2 and recovery time were statistically insignificant (p value > 0.05). There was no desaturation in both the groups. Conclusion: To conclude, LMA (R) Gastro (TM) had performed better in terms of an airway device and ventilatory efficiency even in anticipated difficult airway, on the other hand, Gastro-Laryngeal tube is more conducive for the insertion and maneuvering of a gastro-endoscope.