scholarly journals The ProSeal™ Laryngeal Mask Airway Size Selection in Male and Female Patients in an Asian Population

2005 ◽  
Vol 33 (2) ◽  
pp. 239-242 ◽  
Author(s):  
S. M. Tan ◽  
Y. Y. Sim ◽  
C. K. Koay
Keyword(s):  
Laryngeal Mask Airway ◽  
Mucosal Injury ◽  
Laryngeal Mask ◽  
Asian Women ◽  
Intracuff Pressure ◽  
Leak Pressure ◽  
Female Patients ◽  
Anatomical Position ◽  
Oropharyngeal Leak Pressure ◽  
Asian Men

The aim of this study was to investigate if size 5 compared with size 4 ProSeal™ laryngeal mask airway (PLMA) in Asian men and size 4 compared with size 3 ProSeal™ laryngeal mask airway (PLMA) in Asian women, would give a better glottic seal. We conducted a randomized crossover study involving 30 male and 30 female patients of Asian origin. Size 4 and size 5 PLMA were studied in men and size 3 and size 4 PLMA were studied in women. The patients were anaesthetized and paralysed and the PLMA was inserted with the introducer. The oropharyngeal leak pressure (OLP), ease of insertion, anatomical position, mucosal injury, visibility of cuff in the mouth and volume of air required to achieve an intracuff pressure of 60 cmH2O were studied. In male patients, oropharyngeal leak pressure was higher when size 5 PLMA was used (P<0.001) and there was a higher incidence of mucosal injury (P=0.025). For female patients, oropharyngeal leak pressure was higher with size 4 PLMA (P=0.036) while the number of insertion attempts, anatomical position and mucosal injury were similar. The cuff was not visible in the oral cavity in any cases. The mean volume of air required to achieve an intracuff pressure of 60 cmH2O was less than the maximum recommended by the manufacturers. The size 5 PLMA in Asian men and size 4 PLMA in Asian women resulted in a more effective glottic seal. The use of size 5 PLMA in Asian men led to increased mucosal injury.

A Randomized Crossover Comparison of Airway Sealing with the Laryngeal Mask Airway Ambu AuraFlex at Three Intracuff Pressures in Pediatric Laparoscopic Surgery

2019 ◽  
Author(s):  
Xiang Liu ◽  
Xiaona Tan ◽  
Qi Zhang ◽  
Li Qiao ◽  
Lei Shi
Keyword(s):  
Laparoscopic Surgery ◽  
Laryngeal Mask Airway ◽  
Airway Pressure ◽  
Laryngeal Mask ◽  
Peak Airway Pressure ◽  
Supraglottic Airway ◽  
Intracuff Pressure ◽  
Leak Pressure ◽  
Oropharyngeal Leak Pressure ◽  
Mucosal Change

Abstract Objective An adequate intracuff pressure is important to ensure sufficient sealing function when using supraglottic airway devices to protect the airway from secretions and achieve adequate positive pressure ventilation. The aim of this study is to analyze a feasible and effective alternative Ambu AuraFlex intracuff pressure in child's laparoscopic surgery. Study Design Seventy-two children were included in this study. After insertion of the laryngeal mask airway AuraFlex, oropharyngeal leak pressure (OLP) was measured at intracuff pressures of 10, 30, and 60-cmH2O according to one of six sequences produced on the basis of 3 × 6 Williams crossover design. During the intraoperative period, AuraFlex was maintained using the last intracuff pressure of the allocated sequence. Oropharyngeal leak pressure, peak airway pressure, the fiberoptic view, mucosal change, and complications were assessed at three intracuff pressures. Results The OLP at the intracuff pressure of 10 cmH2O was significantly lower than that of 30 cmH2O (2# 18.1 ± 1.5 vs. 19.5 ± 1.4 cmH2O, p = 0.001; 2.5# 17.7 ± 1.2 vs. 20.2 ± 1.4, p = 0.001) and 60 cmH2O (2# 18.1 ± 1.5 vs. 20.0 ± 1.3 cmH2O, p = 0.002; 2.5# 17.7 ± 1.2 vs. 20.8 ± 1.1, p = 0.003). Compared with the peak airway pressure in pre-and postpneumoperitoneum, the OLP was significantly higher. Subgroup analysis showed no differences in mucosal change and complications. Conclusion Intracuff pressures of 30 may be sufficient for the Ambu AuraFlex in child's laparoscopic surgery, and there may be no added benefit of an intracuff pressure of 60 cmH2O, as oropharyngeal leak pressures were similar.

scholarly journals Appropriate Size of Laryngeal Mask Airway for Children

2002 ◽  
Vol 30 (6) ◽  
pp. 771-774 ◽  
Author(s):  
G. P. Y. Loke ◽  
S. M. Tan ◽  
A. S. B. Ng
Keyword(s):  
Laryngeal Mask Airway ◽  
Crossover Study ◽  
Airway Pressure ◽  
Fibreoptic Bronchoscope ◽  
Laryngeal Mask ◽  
Intracuff Pressure ◽  
Optimal Size ◽  
Leak Pressure ◽  
Gastric Insufflation ◽  
Oropharyngeal Leak Pressure

The aim of this crossover study was to determine the optimal size of laryngeal mask airway in children weighing 10 to 20 kg. In each of 67 apnoeic anaesthetized children, the size 2 and size 2½ laryngeal mask airways were inserted consecutively by a skilled user and the cuff inflated to 60 cmH 2 O. Each LMA was assessed for the ease of insertion (by the number of attempts), oropharyngeal leak pressure, anatomical position (assessed fibreoptically) and the volume of air required to achieve intracuff pressure of 60 cmH 2 O. During the measurement of oropharyngeal leak pressure, the airway pressure was not allowed to exceed 30 cmH 2 O. There was no failed attempt at insertion with any size. The oropharyngeal leak pressure was significantly less for the size 2 LMA compared to the size 2½ LMA (P<0.001). The oesophagus was visible on three occasions, all with the size 2 LMA. Gastric insufflation occurred in three patients, all with the size 2 LMA. The incidence of low oropharyngeal leak pressure (<10 cmH 2 O) was low (9.0%) and all occurred with the size 2 LMA. The fibreoptic bronchoscope scores were not significantly different between the two sizes of LMAs. The volume of air to achieve intracuff pressure of 60 cmH 2 O was much lower than the maximum recommended volume (5.1 ml for size 2 and 6.2 ml for size 2½ ). We conclude that the size 2½ LMA provides a better fit than size 2 in children 10 to 20 kg.

A Comparison of Sex- and Weight-based ProSeal™  Laryngeal Mask Size Selection Criteria

2004 ◽  
Vol 101 (2) ◽  
pp. 340-343 ◽  
Author(s):  
Shinichi Kihara ◽  
Joseph R. Brimacombe ◽  
Yuichi Yaguchi ◽  
Noriko Taguchi ◽  
Seiji Watanabe
Keyword(s):  
Gas Exchange ◽  
Laryngeal Mask Airway ◽  
Mucosal Injury ◽  
Proseal Laryngeal Mask Airway ◽  
Adult Patients ◽  
Laryngeal Mask ◽  
Leak Pressure ◽  
Digital Technique ◽  
Size Selection ◽  
Oropharyngeal Leak Pressure

Background The authors compared the manufacturer's weight-based formula (size 3 for weight &lt; 50 kg, size 4 for weight 50-70 kg, and size 5 for weight &gt; 70 kg) with a sex-based formula (size 4 for women and size 5 for men) for selecting the appropriate size of ProSeal laryngeal mask airway. Methods Two hundred thirty-seven healthy, anesthetized, paralyzed adult patients (American Society of Anesthesiologists physical status I or II; age, 18-80 yr) were randomly allocated for weight- or sex-based size selection. An experienced user inserted the ProSeal laryngeal mask airway with the digital technique. The following were compared: ease of insertion, oropharyngeal leak pressure, ease of ventilation, gas exchange, location of gas leak, anatomic position, mucosal injury, and postoperative pharyngolaryngeal problems. Intraoperative and postoperative data collection were unblinded and blinded, respectively. Results Ease of insertion, anatomic position, gas exchange, mucosal injury, and postoperative pharyngolaryngeal problems were similar between groups. For the sex-based group, larger ProSeal laryngeal mask airways were selected more frequently (P &lt; 0.0001), oropharyngeal leak pressure (P = 0.02) was higher, leak volume (P = 0.004) and leak fraction (P = 0.007) were lower, and oropharyngeal leaks (P = 0.03) were detected less frequently. Conclusion Size selection for the ProSeal laryngeal mask airway is equally effective using the manufacturer's weight-based formula or the sex-based formula in healthy, anesthetized, paralyzed adult patients, but leakage of small volumes of air from the mouth occurs less frequently with the sex-based formula.

Comparison of Three Disposable Extraglottic Airway Devices in Spontaneously Breathing Adults

2006 ◽  
Vol 104 (6) ◽  
pp. 1165-1169 ◽  
Author(s):  
André van Zundert ◽  
Baha Al-Shaikh ◽  
Joseph Brimacombe ◽  
Jurgen Koster ◽  
Dick Koning ◽  
...  
Keyword(s):  
Laryngeal Mask ◽  
Intracuff Pressure ◽  
Leak Pressure ◽  
Anatomical Position ◽  
Oropharyngeal Leak Pressure ◽  
Airway Trauma ◽  
Airway Devices ◽  
Effective Seal ◽  
Extraglottic Airway Devices ◽  
Spontaneously Breathing

Background The authors compared three disposable extraglottic airway devices in spontaneously breathing anesthetized adults: the LMA-Unique (LMA-U; The Laryngeal Mask Company, San Diego, CA), the Soft Seal laryngeal mask (SS-LM; Portex Ltd., Hythe, United Kingdom), and the Cobra perilaryngeal airway (Cobra-PLA; Engineered Medical Systems, Inc. Indianapolis, IN). Methods Three hundred twenty consecutive adults (American Society of Anesthesiologists physical status I-III; aged 18-80 yr) were randomly allocated for airway management with one of the three devices. Anesthesia was with fentanyl-propofol for induction and a sevoflurane-nitrous oxide-oxygen-fentanyl mixture for maintenance. Intraoperative data were collected by an unblinded observer about ease of insertion, effective airway time, oropharyngeal leak pressure, anatomical position (determined with a rigid endoscope), intracuff pressure changes, and airway trauma. Data were collected by a blinded observer about sore throat, dysphagia, and dysphonia 2 h after surgery. Results Insertion was easier with the LMA-U and SS-LM than with the Cobra-PLA (P &lt; 0.02), but the overall failure rates were similar. Effective airway times were similar among groups. Oropharyngeal leak pressure was lower with the LMA-U than with the SS-LM and Cobra-PLA (P &lt; 0.001). Intracuff pressure increased during surgery with all extraglottic airway devices. Anatomical position was better with the Cobra-PLA than with the SS-LMA (P &lt; 0.001) and better with the SS-LM than with LMA-U (P &lt; 0.001). Blood staining was detected more frequently with the Cobra-PLA than with the LMA-U and SS-LM (P &lt; 0.001), but there were no differences in airway morbidity. Conclusion The LMA-U and SS-LM are easier to insert and cause less trauma than the Cobra-PLA, but the Cobra-PLA has a more effective seal than the LMA-U and better endoscopically determined anatomical position than the LMA-U and SS-LM.

scholarly journals Gum-elastic Bougie-guided Insertion of the ProSeal™ Laryngeal Mask Airway: A New Technique

2002 ◽  
Vol 30 (5) ◽  
pp. 624-627 ◽  
Author(s):  
A. Howath ◽  
J. Brimacombe ◽  
C. Keller
Keyword(s):  
Laryngeal Mask Airway ◽  
Gastric Tube ◽  
Cardiovascular Responses ◽  
Laryngeal Mask ◽  
Drainage Tube ◽  
Leak Pressure ◽  
Success Rates ◽  
Tube Insertion ◽  
Oropharyngeal Leak Pressure ◽  
Low Incidence

We determined the success rates, cardiovascular responses and airway morbidity for gum-elastic bougie-guided insertion of the ProSeal™ laryngeal mask airway. One hundred anaesthetized, non-paralyzed adults (ASA 1–2, aged 18 to 80 years) were studied. The ProSeal LMA drainage tube was primed with a well-lubricated 16 French gauge gum-elastic bougie with the curved end proximal and the straight end protruding 30 cm beyond the drainage tube tip. The straight end of the gum-elastic bougie was inserted into the oesophagus under laryngoscopic guidance, the laryngoscope removed and the ProSeal LMA inserted using the standard insertion technique and the gum-elastic bougie as a guide. The following variables were recorded: ease of insertion, oropharyngeal leak pressure, ventilatory capability, ease of gastric tube insertion, blood staining on the bougie or LMA at removal, and postoperative airway morbidity. Haemodynamic data were recorded immediately pre-insertion and every minute for five minutes after insertion. Gum-elastic bougie and ProSeal LMA insertion was successful at the first attempt in all patients within 50 seconds. There were no significant increases in heart rate or blood pressure. Oropharyngeal leak pressure was 33 (17–40) cmH 2 O and ventilation was possible without leak in all patients at 9.5 ml.kg –1 tidal volume. There were no drainage tube or gastric air leaks. Gastric tube insertion was successful at the first attempt in all patients. Blood staining at removal was not detected on the gum-elastic bougie, but was detected in 3% of ProSeal LMAs. The incidence of sore throat, dysphagia and dysarthria was 21%, 9% and 1% respectively. We conclude that gum-elastic bougie-guided insertion of the ProSeal LMA has a high success rate and is associated with minimal haemodynamic change and a low incidence of trauma.

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