Laryngeal mask airway improves hemodynamics and reduces pharyngeal discomfort in total joint arthroplasty

Endotracheal intubation (EI) can adversely affect hemodynamics and patient satisfaction. Concerns regarding the safety of the laryngeal mask airway (LMA) in total joint arthroplasty (TJA) arise from patient positioning and the surgical procedure. This study aimed to compare the effects of EI and LMA on hemodynamics and postoperative pharyngeal discomfort in TJA, and evaluate LMA's safety. In this prospective trial, 100 patients undergoing TJA due to end-stage joint disease at our medical center between August 2023 and August 2024 were enrolled. Following the induction of anesthesia, patients were randomly assigned to either EI or LMA. Postoperative sore throat and hoarseness were assessed upon awakening and at 6, 24, and 48 h. The primary outcome was postoperative pharyngeal discomfort; secondary outcomes were hemodynamic stability and airway complications. At 6 h post-TJA, sore throat (32% vs 12%, P = 0.030) and hoarseness (70% vs 36%, P = 0.003) were significantly lower in the LMA group. At 24 h, hoarseness remained lower (22% vs 6%; P = 0.021). The incidence of hemodynamic instability during airway establishment (40% vs 4%, P < 0.001), removal (78% vs 24%, P < 0.001), and during TJA (62% vs 14%, P < 0.001) was significantly lower in the LMA group. No significant differences in airway complications were found. LMA use in TJA reduced postoperative pharyngeal discomfort and improved hemodynamic stability, making it a safe and effective alternative to EI. Trial registration: The Chinese Clinical Trial Registry (14/08/2023, ChiCTR2300074701).