Comparison of laryngeal mask airway and endotracheal intubation general anesthesia for pulse generator implantation surgery in Parkinson's disease patients

doi:10.3969/j.issn.1006-7795.2025.05.009

Abstract

Abstract: Objective To analyze the application effects of laryngeal mask airway (LMA) general anesthesia versus endotracheal intubation (ETI) general anesthesia in Parkinson's disease (PD) patients undergoing deep brain stimulation (DBS) implantable pulse generator (IPG) surgery. Methods A retrospective analysis was conducted on 164 PD patients who underwent IPG surgery at our hospital from August 2020 to February 2021. Patients were divided into two groups based on airway management: LMA group (n=61) and ETI group (n=103). Perioperative hemodynamic parameters, including mean arterial pressure (MAP) and heart rate (HR), were observed at five time points: pre-induction (T0), post-induction (T1), skin incision (T2), extubation (T3), and post-anesthesia care unit (PACU) admission (T4). Key outcomes, such as extubation time, intraoperative hypoxia events, LMA-to-ETI conversion rate, and postoperative complications (respiratory depression, pneumonia), were compared between the two groups. Results The LMA group had a significantly lower body mass index than the ETI group ［(22.75±3.11 )kg/m² vs (23.85±3.49) kg/m², P=0.039］, while the other baseline characteristics were comparable. After induction, the LMA group exhibited a less decrease in MAP［ (85.46±11.63) mmHg vs (74.13±11.78) mmHg in the ETI group, P<0.001］. At extubation, the ETI group showed higher MAP ［(98.27±13.78) mmHg vs (89.66±10.50) mmHg in the LMA group, P<0.001］. The intraoperative use of vasoactive drugs was significantly lower in the LMA group (3.3%) than that in the ETI group (13.6%, P=0.032). The mean extubation time was shorter in the LMA group［ (8.43±5.25) min vs (14.28±7.66) min in the ETI group, P<0.001］. No intraoperative hypoxia or LMA-to-ETI conversion events occurred in either group. Postoperative respiratory depression and pneumonia rates showed no statistically significant differences between the groups. Conclusion LMA general anesthesia can be safely applied in PD patients undergoing DBS IPG implantation. It shortens extubation time, reduces the use of vasoactive drugs, and does not increase the risk of intubation-related complications.

Key words: Parkinson's disease (PD), , implantable pulse generator (IPG), laryngeal mask airway (LMA), endotracheal intubation (ETI), general anesthesia, deep brain stimulation

CLC Number:

R614

Tong Yuanyuan, Xie Sining, Chen Liang, Li Xiangjiahui, Han Ruquan, Xiong Wei. Comparison of laryngeal mask airway and endotracheal intubation general anesthesia for pulse generator implantation surgery in Parkinson's disease patients[J]. Journal of Capital Medical University, 2025, 46(5): 820-825.

References

［1］ Bloem B R, Okun M S, Klein C. Parkinson's disease［J］. Lancet, 2021, 397(10291): 2284-2303.
［2］ Bucur M, Papagno C. Deep brain stimulation in Parkinson disease: a Meta-analysis of the long-term neuropsychological outcomes［J］. Neuropsychol Rev, 2023, 33(2): 307-346.
［3］李楠，王学廉. 脑深部电刺激疗法的发展历史和临床应用进展［J］. 空军军医大学学报, 2024, 45(12):1474-1477.
［4］朱美琳，程莉莉，董有静. 右美托咪定在脑电双频指数指导及全身麻醉下帕金森病脑深部电刺激术中的应用［J］. 中国医科大学学报, 2021,50(3):276-279.
［5］刘琰，李光宇，王晓旭，等. 帕金森病患者脑深部电刺激术后的非运动症状及其对生活质量的影响［J］. 中国医科大学学报, 2020, 49(1):43-47.
［6］ Sarica C, Iorio-Morin C, Aguirre-Padilla D H, et al. Implantable pulse generators for deep brain stimulation: challenges, complications, and strategies for practicality and longevity［J］. Front Hum Neurosci, 2021, 15: 708481.
［7］ Ni Y, Xiao Y, Shen B, et al. Impact of deep brain stimulation on cognitive impairment in Parkinson's disease: a retrospective longitudinal study［J］. Neurotherapeutics, 2025, 22(3): e00561.
［8］ Nada E M, Rajan S, Grandhe R, et al. Intraoperative hypotension during second stage of deep brain stimulator placement: same day versus different day procedures［J］. World Neurosurg, 2016, 95: 40-45.
［9］刘志永, 丁翠青, 姚长青, 等. 帕金森病患者行下腹或下肢手术全麻苏醒质量及认知功能的变化［J］. 临床麻醉学杂志, 2015, 31(5): 472-475.
［10］ Chaki T, Koizumi M, Tachibana S, et al. Comparing leak pressure of LMA^® ProSeal^TM versus i-gel^® at head rotation: a randomized controlled trial［J］. Can J Anaesth, 2024, 71(1): 66-76.
［11］ Dilmaghani S, Atieh J, Khanna L, et al. Severity of dysphagia is associated with hospitalizations and mortality in patients with Parkinson's disease［J］. Neurogastroenterol Motil, 2022, 34(6): e14280.
［12］ Pinheiro Campos A C, Martinez R C R, Auada A V V, et al. Effect of subthalamic stimulation and electrode implantation in the striatal microenvironment in a Parkinson's disease rat model［J］. Int J Mol Sci, 2022, 23(20): 12116.
［13］ Lu W B, Chang X N, Bo L L, et al. Risk factors for delirium after deep brain stimulation surgery under total intravenous anesthesia in Parkinson's disease patients［J］. Brain Sci, 2022, 13(1): 25.
［14］ Lankhorst S, Keet S W M, Bulte C S E, et al. The impact of autonomic dysfunction on peri-operative cardiovascular complications［J］.Anaesthesia, 2015, 70(3): 336-343.［15］ Wachtendorf L J, Azimaraghi O, Santer P, et al. Association between intraoperative arterial hypotension and postoperative delirium after noncardiac surgery: a retrospective multicenter cohort study［J］. Anesth Analg, 2022, 134(4): 822-833.
［16］李军利, 刘楠楠. 气管插管全麻与喉罩通气全麻应用于脑血管动脉瘤介入栓塞患者的效果比较［J］. 河南医学研究, 2025, 34(1): 69-72.
［17］ Xing Y Q, Li Q, Xu E H, et al. Impaired cerebral autoregulation in Parkinson's disease: an orthostatic hypotension analysis［J］. Front Neurol, 2022, 13: 811698.
［18］ Gong Y H, Xu X H, Wang J, et al. Laryngeal mask airway reduces incidence of post-operative sore throat after thyroid surgery compared with endotracheal tube: a single-blinded randomized controlled trial［J］. BMC Anesthesiol, 2020, 20(1): 16.
［19］ Sollmann M, LM Bode, S Krämer, et al. Superior recovery and efficiency with laryngeal mask airway compared to endotracheal intubation in minimally invasive repair of pectus excavatum: a retrospective analysis［J］. BMC Anesthesiol，2025，25(1):438.

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