Laryngeal Mask Airway versus Natural Airway for Transesophageal Echocardiography: A Retrospective Comparison of Safety and Efficacy.

OBJECTIVE

To determine whether the laryngeal mask airway (LMA) provides superior safety compared to natural airway management during non-operating room transesophageal echocardiography (TEE), focusing on hypoxemia and other periprocedural outcomes.

DESIGN

A single-center retrospective cohort study.

SETTING

Large academic medical center; procedures conducted outside of the operating room between January 2020 and December 2023.

PARTICIPANTS

A total of 1,105 adult patients undergoing elective, nonoperative TEE procedures. Patients were stratified into 2 groups: natural airway (n = 706) and LMA (n = 399).

INTERVENTIONS: Anesthesia care using either natural airway management or an LMA during TEE procedures. The choice of technique was at the discretion of the anesthesia provider.

MEASUREMENTS AND MAIN

RESULTS

The primary outcome was the incidence of hypoxemia, defined as SpO₂ <90%. Secondary outcomes included hypoxemia duration, conversion to endotracheal intubation, anesthesia duration, operative duration, postanesthesia care unit length of stay, and 30-day mortality. Baseline characteristics were similar in the 2 groups. Hypoxemia occurred in 19.0% of LMA patients versus 49.0% in the natural airway group (p < 0.001), with a number needed to treat of 3.3. The median duration of hypoxemia was shorter with LMA (1 minute v 3 minutes; p < 0.001). Fewer LMA patients required intubation (1.0% v 2.1%; p < 0.001). Thirty-day mortality was 0% in the LMA group and 1.3% in the natural airway group (p = 0.023). LMA remained independently associated with reduced hypoxemia after multivariable adjustment (adjusted odds ratio, 0.19; 95% confidence interval, 0.14-0.26; p < 0.001).

CONCLUSIONS

LMA use during TEE is associated with reduced hypoxemia, shorter recovery, and lower mortality. These findings support the potential benefits of LMA as a safer airway management strategy for TEE.