• L Q Yang, L Zhu, X Shi, C H Miao, H B Yuan, Z Q Liu, W D Gu, F Liu, X X Hu, D P Shi, H W Duan, C Y Wang, H Weng, Z L Huang, L Z Li, Z Z He, J Li, Y P Hu, L Lin, S T Pan, S H Xu, D Tang, D I Sessler, J Liu, M G Irwin, W F Yu, and POLMA-EP investigators.
• Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
• Anaesthesia. 2023 Aug 1; 78 (8): 953962953-962.

AbstractThe two most commonly used airway management techniques during general anaesthesia are supraglottic airway devices and tracheal tubes. In older patients undergoing elective non-cardiothoracic surgery under general anaesthesia with positive pressure ventilation, we hypothesised that a composite measure of in-hospital postoperative pulmonary complications would be less frequent when a supraglottic airway device was used compared with a tracheal tube. We studied patients aged ≥ 70 years in 17 clinical centres. Patients were allocated randomly to airway management with a supraglottic airway device or a tracheal tube. Between August 2016 and April 2020, 2900 patients were studied, of whom 2751 were included in the primary analysis (1387 with supraglottic airway device and 1364 with a tracheal tube). Pre-operatively, 2431 (88.4%) patients were estimated to have a postoperative pulmonary complication risk index of 1-2. Postoperative pulmonary complications, mostly coughing, occurred in 270 of 1387 patients (19.5%) allocated to a supraglottic airway device and 342 of 1364 patients (25.1%) assigned to a tracheal tube (absolute difference -5.6% (95%CI -8.7 to -2.5), risk ratio 0.78 (95%CI 0.67-0.89); p < 0.001). Among otherwise healthy older patients undergoing elective surgery under general anaesthesia with intra-operative positive pressure ventilation of their lungs, there were fewer postoperative pulmonary complications when the airway was managed with a supraglottic airway device compared with a tracheal tube.© 2023 Association of Anaesthetists.

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