Laryngeal mask airway versus endotracheal tube for preventing postoperative atelectasis after laparoscopic surgery: a randomized controlled trial

Background Postoperative atelectasis is a common and clinically significant complication of general anesthesia, particularly during laparoscopic surgery due to reduced lung compliance and diaphragmatic elevation. In this study, the effects of a laryngeal mask airway (LMA) and endotracheal tube (ETT) on postoperative atelectasis after laparoscopic surgery were compared, and a predictive model for lung injury was developed. We hypothesized that the use of a laryngeal mask airway would be associated with reduced postoperative atelectasis compared with endotracheal intubation in patients undergoing laparoscopic surgery. Methods In this single-center, assessor-blinded randomized controlled trial (ChiCTR2400094097), 192 adults (American Society of Anesthesiologists physical status I–III) undergoing elective laparoscopy (gastrointestinal, biliary, hernia, or gynecologic procedures) were randomized to LMA ( n = 96) or ETT ( n = 96) groups. All patients received lung-protective ventilation. Intraoperative respiratory mechanics (dynamic compliance and peak pressure) were monitored. Lung ultrasound (LUS) of 12 zones was performed preoperatively and 10 min after extubation by blinded investigators. An XGBoost model with SHAP identified predictors of LUS deterioration. The primary outcome was the LUS score (preoperative and 10 min postextubation). Results In total, 186 patients completed follow-up. The ETT group showed significantly higher postoperative LUS scores compared with the LMA group (8.1 ± 1.9 vs. 5.6 ± 2.4, P < 0.001) as well as higher pulmonary complication rates (14% vs. 5.4%, P = 0.047). Airway complications, such as sore throat, were less frequent with LMA use. The XGBoost–SHAP model identified the intraoperative dynamic compliance decay rate as the strongest predictor of LUS deterioration. Conclusions In laparoscopic surgery, laryngeal mask airway use is associated with reduced postoperative atelectasis and pulmonary complications compared with endotracheal intubation. Intraoperative deterioration in lung compliance may serve as an early indicator of postoperative lung aeration impairment detected by lung ultrasound. Clinical Trial Registration https://www.chictr.org.cn/showproj.html?proj=254374 , Registration number: ChiCTR2400094097