Video Laryngeal Mask vs. Endotracheal Tube in Septoplasty

This prospective, randomized controlled trial will compare the efficacy and safety of a video laryngeal mask airway (VLMA) versus a standard endotracheal tube (ETT) for airway management in adult patients (aged 18-65, ASA physical status I-II) undergoing elective septoplasty under general anesthesia.

Participants will be randomly assigned to receive either a video-assisted supraglottic airway (VLMA) or a conventional endotracheal tube (ETT). The primary objective is to evaluate whether VLMA can provide better protection against blood contamination in the glottic and subglottic regions compared to ETT. Secondary objectives include assessments of perioperative hemodynamic stability, respiratory performance, postoperative airway-related complications, and overall recovery.

All patients will undergo standardized anesthesia induction (e.g., propofol plus an opioid) and maintenance with inhalational agents and/or remifentanil infusion. Depth of anesthesia will be monitored using the bispectral index (BIS), along with standard ASA monitoring. Respiratory parameters (tidal volume, end-tidal CO₂, peak and plateau airway pressures) will be recorded throughout the procedure. Hemodynamic data (heart rate, systolic and diastolic arterial pressures) will be measured at predefined time points: pre-induction, post-airway insertion, and post-extubation.

At the end of surgery, blood contamination within the airway will be assessed at two anatomical levels:

Distal trachea: In both groups, a fiberoptic bronchoscope will be used for evaluation. In the ETT group, the bronchoscope will be inserted through the endotracheal tube before removal. In the VLMA group, the bronchoscope will be passed through the lumen of the VLMA prior to removal.

Glottis/tracheal inlet: This region will be assessed only in the VLMA group, using the device's integrated video camera to obtain a direct visual inspection before removal.

A standardized four-point scale adapted from Kaplan et al. will be used to rate the degree of blood contamination:

1. = No visible blood, 2. = Mild contamination, 3. = Moderate contamination, 4. = Severe contamination with diffuse blood.

Following airway device removal, all patients will be transferred to the post-anesthesia care unit (PACU) and monitored until achieving an acceptable Aldrete score. Postoperative airway-related symptoms-such as sore throat, hoarseness, dysphagia, and cough-will be assessed at 2, 8, 12, 24, and 48 hours. Additional data including total anesthesia duration, airway insertion time, and any adverse events (e.g., laryngospasm, bronchospasm, desaturation, or need for airway repositioning) will also be documented.

This study aims to determine whether VLMA offers advantages over ETT in terms of airway protection, intraoperative stability, and postoperative comfort in septoplasty surgery.

• Heart Rate (HR) [Срок оценки: From preoperative baseline until arrival to the recovery unit (approximately 120 minutes).]
• Postoperative Sore Throat (POST Score) [Срок оценки: Up to 48 hours postoperatively.]
• Arterial Blood Pressure (Systolic, Diastolic, and Mean) [Срок оценки: From preoperative baseline until arrival to the recovery unit (approximately 120 minutes).]
• Total Remifentanil Consumption [Срок оценки: Intraoperative]
• Airway Insertion Time [Срок оценки: Immediately after induction of anesthesia]
• Intraoperative Airway Complications [Срок оценки: From induction of anesthesia to extubation (intraoperative period)]
• Postoperative Dysphagia (Swallowing Difficulty) [Срок оценки: Up to 48 hours postoperatively.]
• First-Attempt Success Rate of Airway Device Insertion [Срок оценки: Immediately after induction of anesthesia.]
• Postoperative Nausea and Vomiting (PONV) [Срок оценки: Up to 48 hours postoperatively.]
• Airway Pressure Parameters (Peak and Mean Airway Pressure) [Срок оценки: From 1 minute to 30 minutes after airway device placement.]
• Anesthesia Duration [Срок оценки: Intraoperative period (approximately 60-120 minutes)]
• Surgical Duration [Срок оценки: Intraoperative period (approximately 30-120 minutes)]