The global prevalence of adult cerebral aneurysms is estimated to be between 0.65% and 3.2%. With the continuous improvement of screening and imaging technology, the detection rate of cerebral aneurysms has continued to increase. For the treatment of cerebral aneurysms, craniotomy clipping presents greater surgical trauma and risk, while endovascular interventional therapy achieves occlusion of intracranial aneurysms by implanting stents into the aneurysm and releasing a coil. Due to its minimally invasive nature, safety, and effectiveness, it has been widely used in clinical practice in recent years [4, 15–19]. Cerebral aneurysm embolization is an intravascular operation associated with mild stimulation. The operation time is usually 1–2 hours. During the operation, the patient's head should be kept totally still. During general anesthesia, it is necessary to perform mechanical ventilationin order not to interfere with the contrast imaging.
The primary goal of anesthesia management for cerebral aneurysm embolization are to maintain the stability of perioperative circulation, to keep the patient's head immobilization during the operation and to promptly deal with intraoperative complications . At present, the most common anesthesia methods are sedation and general anesthesia. Simple sedation allows convenient and frequent neurological evaluations, avoiding tracheal intubation and related hemodynamic changes. The disadvantage is that it does not protect the airway, and there is a risk of reflux aspiration and potential hypoxemia and hypercapnia. Sudden movements and delayed management of neurological emergencies may also occur [20, 21]. The main advantages of general anesthesia are that patients remain still, improving imaging quality, and increasing safety and efficiency. If complications occur, it is convenient to deal with them. However, hemodynamic fluctuations caused by anesthesia induction and tracheal intubation and the inability to continuously assess the patient's neurological status are its main disadvantages . The traditional method of general anesthesia for cerebral aneurysm embolization is to use tracheal intubation and general anesthesia. General anesthesia with tracheal intubation requires deeper anesthesia and proper muscle relaxation during the induction as well as maintenance of anesthesia. During tracheal intubation and extubation, there are often substantial hemodynamic fluctuations that are extremely harmful to patients with aneurysms; these often cause serious adverse reactions such as cerebral aneurysm rupture and hemorrhage [22, 23].
As a supraglottic ventilation tool, LMA avoids direct irritation to glottis and trachea. It has been widely used since its introduction in the US in 1988[12, 24, 25]. The double lumen LMA is used in various operations because it greatly reduces reflux and aspiration . A study showed that general anesthesia using laryngeal mask airway not only reduced hemodynamic fluctuation during surgery, but it also allowed the patients to be awakened quickly . Nevertheless, although LMA placement avoids direct irritation and injury to the glottis and trachea, it can damage soft tissues of the mouth, pharynx and larynx. Pharyngeal pain and bleeding are common postoperative complications . During cerebral aneurysm embolization with LMA Supreme general anesthesia, we found that patients who received anticoagulant and antiplatelet aggregation therapy experienced significantly increased pharyngeal pain and bleeding after surgery. Therefore, based on the characteristics of this kind of surgery for perioperative anticoagulant patients, we need a ventilation device that not only ensures effective ventilation but also reduces oropharyngeal injuries. As a special type of laryngeal mask, the endoscopic laryngeal mask airway has been shown to be safe and effective in upper gastrointestinal endoscopic surgery .There are also reports on its application in minimally invasive cardiovascular surgery such as atrial fibrillation radiofrequency ablation.
Based on its special material and structural characteristics of the Jcerity Endoscoper Airway, we used it to manage the airway in cerebral aneurysm embolization. On one hand, the large-volume inflatable cuff is made of silica gel material, which has high elasticity and flexibility, on the other hand, it fits the anatomical curve of each patient's oropharynx, and forms an effective sealing area in the throat, in particular, it could avoid injury to the throat caused by excessive inflation compression. Studies have shown that the incidence of postoperative sore throat is not only related to implantation trauma, but also to long-term compression of the laryngeal mask .
As a new type of LMA specially developed for upper gastrointestinal endoscopy, the Jcerity Endoscoper Airway's innovation is to add a dedicated endoscopic channel (20*22 mm inner diameter) that runs in parallel with an independent airway channel with a terminal cuff. Its endoscopic examination channel is not completely closed, which greatly reduces the friction area between the laryngeal mask and the posterior pharynx wall during the insertion process. The most important thing is that the main tube adopts a fixed angle and streamlined design, and the head end of the cuff is a semi-open buffer sheet structure, which minimizes the resistance damage to the oropharynx and the mucosa around the glottis during the placement process. The LMA Supreme ventilation cavity is reinforced with steel wire. To prevent LMA Supreme folding during the insertion process, a hard guidewire is built in for shaping, and the tip of the suction cavity is relatively hard. Therefore, during insertion, especially when pulling out the guidewire, the head end of the LMA Supreme inflicts substantial resistance damage to the throat. In our study, we found that both the LMA Supreme and the Jcerity Endoscoper Airway provided safe and effective airway protection for patients undergoing general anesthesia for cerebral aneurysm embolization. There were no significant differences in terms of success rate of implantation, implantation time, difficulty of implantation, fiberoptic bronchoscopy field of vision, ventilation quality, intraoperative airway pressure, orsealing pressure. Due to the specificity of cerebral aneurysm embolization, compared with the LMA Supreme group, the blood staining degree of the mask, postoperative sore throat, postoperative oral hemorrhage in the Jcerity Endoscoper Airway group were significantly lower, which may be related to its particular material composition and structure.
In conclusion, compared with LMA Supreme, Jcerity Endoscoper Airway significantly reduced postoperative pharyngeal pain and oral bleeding in patients undergoing interventional embolization under general anesthesia for treatment of cerebral aneurysms.