Nishino T: Laryngeal reflex before and after placement of airway interventions: Endotracheal tube and laryngeal mask airway. ANESTHESIOLOGY

Background: Previous reports indicate that detrimental laryngeal function persists over several hours after tracheal extubation even in patients who have regained full consciousness from anesthesia. The authors hypothesize that even after minor surgery, the presence of an endotracheal tube (ETT) impairs the receptors at the vocal cord and diminishes the defensive laryngeal function. The hypothesis was tested by comparing types of experimentally induced laryngeal airway reflexes before and after surgery in anesthetized patients with use of either an ETT or a Laryngeal Mask Airway™. Methods: Twenty adult patients undergoing elective minor surgeries were randomly allocated into two groups, the ETT and Laryngeal Mask Airway™ groups, depending on the airway management method used during surgery. While maintaining sevoflurane at 1 minimum alveolar concentration, laryngeal and respiratory responses were elicited by instillation of distilled water on the vocal cords immediately before and after surgery. Furthermore, the vocal cord angles were endoscopically measured under complete paralysis. Results: Some laryngeal reflex responses of both groups, particularly the cough reflex, were significantly attenuated after minor surgery. Significant narrowing of the glottic aperture was evident in patients with ETT placement but not in patients with Laryngeal Mask Airway™ placement. Conclusions: With either airway intervention, laryngeal defensive reflexes are depressed immediately after surgery even without visible laryngeal swelling. The sensory impairment attributable to the presence of an ETT cannot be the solo factor responsible for the modification of the defensive airway reflexes elicited from the larynx