Head Rotation Reduces Oropharyngeal Leak Pressure of the i-gel and LMA® Supreme™ in Paralyzed, Anesthetized Patients

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

American Journal of Perinatology ◽

10.1055/s-0039-1696643 ◽

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.

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Mucosal Pressure and Oropharyngeal Leak Pressure with the ProSeal Versus Laryngeal Mask Airway in Anaesthetized Paralysed Patients

Survey of Anesthesiology ◽

10.1097/00132586-200108000-00023 ◽

2001 ◽

Vol 45 (4) ◽

pp. 212

Keyword(s):

Laryngeal Mask Airway ◽

Laryngeal Mask ◽

Leak Pressure ◽

Oropharyngeal Leak Pressure ◽

Mucosal Pressure

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

Anaesthesia and Intensive Care ◽

10.1177/0310057x0503300214 ◽

2005 ◽

Vol 33 (2) ◽

pp. 239-242 ◽

Cited By ~ 12

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.

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