Comparison of Classic Laryngeal Mask Airway and Endotracheal Intubation for Airway Management During Short Urologic Procedures in the Prone Position: A Randomized Controlled Trial

Background

Airway management in the prone position remains a major challenge in anesthesia, particularly during short urologic procedures. Although endotracheal intubation (ETT) is considered the standard technique, the Classic laryngeal mask airway (LMA) has emerged as a less invasive alternative in patients without an anticipated difficult airway. This study aimed to compare the efficacy and safety of Classic LMA versus ETT for airway management in prone‐position urologic surgeries.

Methods

In this randomized clinical trial, 70 patients undergoing prone‐position urologic surgery with an operative duration of ≤ 90 min were assigned to either the Classic LMA group or ETT group ( n  = 35 each). Primary outcomes included intraoperative ventilatory performance assessed by peak airway pressure (Ppeak), need for conversion of airway technique, and airway‐related complications. Secondary outcomes included intraoperative hemodynamic and respiratory parameters, including heart rate (HR), systolic and diastolic blood pressure (SBP/DBP), oxygen saturation (SpO ₂ ), end‐tidal carbon dioxide (ETCO ₂ ), Ppeak, minute ventilation (VE), and postoperative complications.

Results

Baseline demographic and perioperative characteristics were comparable between groups. No significant differences were observed between the Classic LMA and ETT groups regarding intraoperative hemodynamic variables, SpO ₂ , ETCO ₂ , or VE. Ppeak was significantly higher in the ETT group ( p < 0.001). During recovery, significant time‐related changes were observed in hemodynamic and respiratory parameters in both groups, although no clinically significant intergroup differences were identified. Postoperative complications, including sore throat and laryngospasm, were infrequent and comparable between groups.

Conclusion

Classic LMA provided airway maintenance and ventilation comparable to ETT in short prone‐position urologic surgeries and may be considered as a feasible airway device in patients meeting appropriate airway assessment criteria.

Trial Registration: Iranian Registry of Clinical Trials (IRCT): IRCT20250729066688N1