Intubation via a laryngeal mask airway with an Aintree catheter – not all laryngeal masks are the same

Abstract Background : Hyperinflation of laryngeal mask cuffs may carry the risk of airway complications. The manufacturer recommends inflating cuff until the intracuff pressure reaches 60 cmH 2 O, or inflate with the volume of air to not exceed the maximum recommended volume. We prospectively assessed the correlation of cuff inflating volumes and pressures, and the appropriated the cuff inflating volumes to generate an intracuff pressure of 60 cmH 2 O in the adult laryngeal masks from different manufacturers. Methods : Two groups of eighty patients requiring laryngeal mask size 3 and 4 during general anesthesia were randomized into 4 subgroups for each size of the laryngeal mask: Soft Seal ® (Portex ® ), AuraOnce TM (Ambu ® ), LMA-Classic TM (Teleflex ® ) and LMA-ProSeal TM (Teleflex ® ). After insertion, the cuff was inflated with 5-ml increments of air up to the maximum recommended volume. After each 5-ml intracuff pressure was measured, the volume of air that generated the intracuff pressure of 60 cmH 2 O was recorded . Results : Mean(SD) volume of air required to achieve the intracuff pressure of 60 cmH 2 O in Soft Seal ® , AuraOnce TM , LMA-Classic TM , LMA-ProSeal TM laryngeal mask size 3 were 11.80(1.88), 9.20(1.88), 8.95(1.50) and 13.50(2.48) ml, respectively, and these volumes in laryngeal mask size 4 were 14.45(4.12), 12.55(1.85), 11.30(1.95) and 18.20(3.47) ml, respectively. The maximum recommended volume resulted in high intracuff pressures (>60 cmH 2 O) in all laryngeal mask types and sizes studied. Conclusion : Pressure-volume curves of adult laryngeal masks are all in sigmoidal shape. Cuff designs and materials can effect pressure and volume correlation. Approximately half of the maximum recommended volume is required to achieve the intracuff pressure of 60 cmH 2 O except LMA-ProSeal TM which required two-thirds of the maximum recommended volume. Trial registration: Thai Clinical Trials Registry, TCTR20150602001, May 28, 2015

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Safety and Efficacy of a Novel Intubating Laryngeal Mask during the recovery period following Supratentorial Tumour Surgery

Journal of International Medical Research ◽

10.1177/0300060521999768 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199976

Author(s):

Xiaomei Ling ◽

Xuemeng Chen ◽

Gaowang Liu ◽

Xianfeng Ma ◽

Ming Xiao ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Bispectral Index ◽

Recovery Period ◽

Laryngeal Mask ◽

The Novel ◽

Laryngeal Masks ◽

Safety And Efficacy ◽

Endotracheal Tubes ◽

Parallel Group ◽

Surgical Drain

Objective To assess safety and efficacy of a novel intubation laryngeal mask airway (ILMA) during the recovery period following supratentorial tumour surgery. Methods Patients who underwent supratentorial tumour surgery at our centre from January 2012 to December 2016 were eligible for this prospective randomised, parallel group study. We developed a novel ILMA using closely fitting laryngeal masks (No. 4/5) with 7.0/7.5 mm endotracheal tubes (ETT) plus screw fixators and anti-pollution sleeves. Results In total, 100 patients were intubated with the novel ILMA and 100 the ETT. There were no differences between groups in haemodynamic variables, oxygen saturation, exhaled CO2, or bispectral index all recorded during the 72-hour recovery period. However, there were significantly fewer incidences of coughing, less fluid drainage and lower haemoglobin levels in surgical fluid in the ILMA group compared with the ETT group. Conclusion Our novel ILMA device was associated with reduced coughing, fluid drainage and blood in surgical drain during the recovery period following supratentorial tumour surgery.

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Antichemical Protective Gear Prolongs Time to Successful Airway Management

Anesthesiology ◽

10.1097/00000542-200402000-00013 ◽

2004 ◽

Vol 100 (2) ◽

pp. 260-266 ◽

Cited By ~ 38

Author(s):

Ron Flaishon ◽

Alexander Sotman ◽

Ron Ben-Abraham ◽

Valery Rudick ◽

David Varssano ◽

...

Keyword(s):

Laryngeal Mask Airway ◽

Tracheal Intubation ◽

Airway Management ◽

Mass Casualty ◽

Laryngeal Mask ◽

Laryngeal Mask Airway Insertion ◽

Laryngeal Masks ◽

Airway Control ◽

Protective Gear ◽

The Mean

Background Airway management is the first step in resuscitation. The extraordinary conditions in mass casualty situations impose special difficulties in airway management, even for experienced caregivers. The authors evaluated whether wearing surgical attire or antichemical protective gear made any difference in anesthetists' success of airway control with either an endotracheal tube or a laryngeal mask airway. Methods Fifteen anesthetists with 2-5 yr of residency and wearing either full antichemical protective gear or surgical attire intubated or inserted laryngeal masks in 60 anesthetized patients. The study was performed in a prospective, randomized, crossover manner. The duration of intubation/insertion was measured from the time the device was grasped to the time a normal capnography recording was obtained. Results Endotracheal tubes were introduced significantly (P < 0.01) faster when the anesthetist wore surgical attire (31 +/- 7 vs. 54 +/- 24 s for protective gear), but the mean times necessary to successfully insert laryngeal masks were similar (44 +/- 20 s for surgical attire vs. 39 +/- 11 s for protective gear). Neither performance failure nor incidences of hypoxemia were recorded. Conclusions This first report in humans shows to what extent anesthetists' wearing of antichemical protective gear slows the time to intubate but not to insert a laryngeal mask airway compared with wearing surgical attire. Laryngeal mask airway insertion is faster than tracheal intubation when wearing protective gear, indicating its advantage for airway management when anesthetists wear antichemical protective gear. If chances for rapid and successful tracheal intubation under such chaotic conditions are poor, laryngeal mask airway insertion is a viable choice for airway management until a proper secured airway is obtainable.

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