Impact of the anesthetic technique: desflurane, sevoflurane or propofol on the performance of the LMA Protector TM in anesthetized adult patients. A comparative study of non-inferiority

Background: The laryngeal mask (LM) Protector™ (LMP) is a second-generation supraglottic airway device associated with high oropharyngeal leak pressure (OLP). Anesthetic technique is one factor influencing OLP. Objective: To evaluate the OLP of the LMP using desflurane, comparing it for non-inferiority to sevoflurane and propofol, and to assess the relationship between respiratory adverse events and anesthetic agent. Methods: This prospective, observational cohort study included 180 ASA physical status I-III adult patients (aged 18-75 years) undergoing outpatient surgery requiring an LMA. All patients received midazolam (1 mg IV), remifentanil (0.25 µg kg⁻¹ min⁻¹), and propofol (2.5-3 mg kg⁻¹) before LMP insertion without neuromuscular blockade. Anesthesia was maintained with desflurane, sevoflurane, or propofol. OLP and respiratory complications were recorded. Results: Demographic parameters were similar across groups, except for a lower percentage of women in the sevoflurane group and similar rates of advanced airway use. OLP [median (range), cm H₂O] was 28 (22-34) for desflurane, 26 (22-32) for sevoflurane, and 28 (25-34) for propofol (p = 0.62). Initial and maintenance ventilation characteristics were comparable across groups, as was the incidence of respiratory complications (coughing, laryngospasm, desaturation), which were generally mild. Conclusion: The LMP provides effective airway management with high OLP, irrespective of the anesthetic agent (desflurane, sevoflurane, or propofol) used. No significant differences in OLP or respiratory complications were observed among the anesthetic groups.