الفهرس 
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Abstract
The ability to maintain an adequate airway is one of the major responsibilities of anaesthesiologists. Interruption of gas exchange, for even a few minutes, can result in undesirable outcomes such as brain ischemia or even brain damage or death.
The use of endotracheal intubation has not only made administration and maintenance of anaesthesia easy, but has also helped in saving several lives. Endotracheal intubation is usually carried out under direct vision using the direct laryngoscopy.
In the last years, a number of supraglottic airway devices have been introduced in the clinical practice of the airway management, trying to offer a simple and effective alternative to the endotracheal intubation.
Despite an increase in the number of patients with hepato-biliary tract diseases, surgical treatment is limited along with risky outcomes such as bleeding, infection or improper postoperative pain control. ERCP is another treatment of choice which has some advantages over surgery. It is a procedure that combines the use of a flexible upper gastrointestinal endoscope with X-ray pictures to assess the biliary system.
ERCP is usually performed in the prone position but it may be performed in the lateral or supine position under moderate or deep sedation, or under general anaesthesia. When general anaesthesia is used, airway protection can be achieved with an endotracheal tube or the GLT.
The GLT is a modification of the Laryngeal Tube which provides a dedicated channel for the insertion of a gastroscope, while acting as a supraglottic airway for ventilation. The GLT is used for performing short term or minor duodenal and esophageal gastric endoscopies whenever the patient has particular high risk factors or refuses conscious sedation and asks for deep sedation or anaesthesia.
The present study is designed to compare the GLT and ETT as regards adequacy of ventilation during controlled ventilation, haemodynamic responses and respiratory complications.
After approval of Local Ethics Committee and written informed consent of all patients, the present study was carried out in Alexandria Main University Hospital on 40 adult patients, ASA physical status II and III, admitted to Alexandria Main University Hospital, scheduled to undergo ERCP under general anaesthesia.
Sample size was statistically approved by the biostatistics department of the High Institute of Public Health Alexandria University.
Patients were randomly divided into two equal groups by patient closed envelope method according to the airway technique used.
Group І: 20 patients were ventilated using Gastro Laryngeal Tube.
Group ІІ: 20 patients were ventilated using the endotracheal tube.
Regarding heart rate and mean arterial blood pressure, the results of the present study revealed that, there was no significant difference between both groups at different times except after placement of the airway device and 2 minutes after insertion of the airway device.
As regards the Oxygen saturation and end-tidal CO2, the current study revealed that there was no significant difference between both groups at different times during the study.
There was no statistically significant difference between the two studied groups regarding number of trials for insertion of the airway device which ranged between 1 and 2 trials in both groups.
Regarding the time required for placement of the airway device, the present study revealed that there was a significant difference between both groups being shorter while using the GLT for airway management.
When both groups were compared regarding the airway intervention required. The current study revealed that only one case in GLT group required repositioning of the head and neck and lateral movement of the tube. In the ETT group, three cases required external laryngeal compression to facilitate insertion of the ETT.
The surgeon satisfaction was greater significantly in group I than in group II, because most surgeons were satisfied with the ease of insertion of the endoscope, ease of manipulation and the protection of the endoscopic fibers from biting by patients’ teeth.
from the present study, we can conclude that GLT is an effective device for airway management during ERCP. It facilitates the insertion of the endoscope and it provides efficient protection to the endoscopic fibers. Also, the GLT help to attenuate the hemodynamic stress response that occurs usually with the ETT tube insertion.