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cuff volume and size laryngeal mask Airway

Sidharth Verma, Nitika Mehta, Nandita Mehta, Satish Mehta, Jayeeta Verma
We present a case of confusing white foreign body in the nasal cavity detected during Endoscopic Sinus Surgery (ESS) in a 35-yr-old male which turned out to be a malposition of classic laryngeal mask airway (LMA). Although malposition of LMA is a known entity to the anesthesiologist, if ventilation is adequate, back folded LMA in nasal cavity might not be recognized by the surgeon and lead to catastrophic consequences during endoscopic sinus surgery. In principle, misfolding and malpositioning can be reduced by pre usage testing, using appropriate sizes, minimizing cuff volume, and early identification and correction of malposition...
October 2015: Middle East Journal of Anesthesiology
Bing-Bing Li, Jie Yan, Hong-Gang Zhou, Jing Hao, Ai-Jia Liu, Zheng-Liang Ma
BACKGROUND: High intracuff pressure can cause severe pharyngeal complications including sore throat or hoarseness after laryngeal mask airway (LMA) removal postoperatively. Though the application of minimum effective cuff inflating volume is suggested to maintain airway sealing and adequacy of ventilation for patients receiving general anesthesia with LMA at lower level of the intracuff pressure, it is currently not a standard care in most of the anesthetic departments. In this study, the minimum effective cuff inflating volume was determined for classic LMA Well Lead™ (Well Lead Medical Co...
October 5, 2015: Chinese Medical Journal
Zehra İpek Arslan, Canan Balcı, Duygu Akalın Oysu, Mehmet Yılmaz, Necla Gürbüz, Zekeriya Ilce
OBJECTIVE: The aim of this study was to compare size 2 Laryngeal Mask Airway ProSeal and size 2 Laryngeal Mask Airway Supreme in spontaneously breathing children undergoing lower abdominal elective surgery of <1 hour duration. STUDY DESIGN: Randomized clinical trial. MATERIAL AND METHODS: Sixty children aged 1-7 years, weighing 10-20 kg, ASA I physical status were randomly allocated to the Laryngeal Mask Airway ProSeal and Laryngeal Mask Airway Supreme...
March 2013: Balkan Medical Journal
P N Robinson, A Shaikh, N M Sabir, D J A Vaughan, M Kynoch, M Hasan
The Tulip airway is an adult, disposable, single-sized oropharyngeal airway, that is connectable to an anaesthetic circuit. After a standardised induction of anaesthesia in 75 patients, the ease of insertion, intracuff pressure and intracuff volume were measured, as were the end-tidal carbon dioxide levels, airway pressures and tidal volumes over three breaths. Successful first-time insertion was achieved in 72 patients (96%, CI 88.8-99.2%) and after two attempts in 74 patients (99%, CI 92.8-100%). There was outright failure only in one patient...
July 2014: Anaesthesia
R Vasanth Karthik, Priya Ranganathan, Atul P Kulkarni, Kailash S Sharma
PURPOSE: The incidence of postoperative pharyngolaryngeal complications after laryngeal mask airway (LMA) insertion can be as high as 50%. Over-inflation of the LMA cuff may be a causal factor. We conducted a single-centre parallel group randomised trial to determine whether maintaining LMA-ProSeal intra-cuff pressures below 60 cm H2O decreases postoperative pharyngolaryngeal complications. METHODS: We recruited 120 adult patients who were scheduled to undergo elective surgery under general anaesthesia...
October 2014: Journal of Anesthesia
Min-Soo Kim, Jeong-Rim Lee, Yang-Sik Shin, Ji-Won Chung, Kyu-Ho Lee, Ki Ryang Ahn
PURPOSE: This single-center, prospective, randomized, double-blind, 2-arm, parallel group comparison trial was performed to establish whether the adult-sized laryngeal mask airway (LMA) Classic (The Laryngeal Mask Company Ltd, Henley-on-Thames, UK) could be used safely without any consideration of cuff hyperinflation when a cuff of the LMA Classic was inflated using half the maximum inflation volume or the resting volume before insertion of device. BASIC PROCEDURES: Eighty patients aged 20 to 70 years scheduled for general anesthesia using the LMA Classic were included...
March 2014: American Journal of Emergency Medicine
Jacek Wadełek, Julia Kolbusz, Piotr Orlicz, Andrzej Staniaszek
BACKGROUND: Anaesthetic complications, albeit rare, still occur and may be severe and unanticipated, with significant morbidity. Extracranial ipsilateral palsy of the recurrent laryngeal and the hypoglossal nerves is known as the Tapia's syndrome. Damage to these nerves may result from displacement of the head during mask ventilation, endotracheal intubation, bronchoscopy or the use of a laryngeal mask airway (LMA). We describe unilateral paralysis of the muscles of the tongue and ipsilateral vocal cord due to a lesion of cranial nerves X and XII that occurred following LMA anaesthesia combined with plexus block...
January 2012: Anaesthesiology Intensive Therapy
Babita Ghai, Sameer Sethi, Jagat Ram, Jyotsna Wig
BACKGROUND: Clinical end points are often used to guide inflation and adequacy of cuff seal after laryngeal mask airway placement. However, clinical end points for cuff inflation have been shown to have significantly higher intracuff pressure. The adjusted cuff pressure between 55 and 60 cm H(2)O causes significantly better seal of laryngeal mask airway. We prospectively assessed the cuff pressures generated by cuff inflation guided by clinical end points, and the actual volume of air required to achieve cuff pressures between 55 and 60 cm H(2)O for sizes 1-2...
February 2013: Paediatric Anaesthesia
Bo-Eun Moon, Min-Soo Kim, Jeong Rim Lee
BACKGROUND: The cuff of the laryngeal mask airway (LMA) is preferred to be partially inflated before insertion in pediatric cases. However, it is not known how much inflation is appropriate. In addition, intra-cuff pressure is not routinely monitored in many institutions despite the fact that a neglected high cuff pressure could cause several complications. This study was conducted to determine whether the cuff inflated with its resting volume before insertion could have a clinically tolerable intra-cuff pressure after insertion...
June 2012: Korean Journal of Anesthesiology
Takanobu Uesugi, Masaaki Tanimoto
BACKGROUND: Although the cases of upper airway obstruction with ProSeal laryngeal mask airway (PLMA) during spontaneous respiration were reported, the structural comparison with other types of laryngeal mask are not known. We thus examined the relationship between upper airway obstruction and the structure of laryngeal mask. METHODS: With approval of the human research committee at Kawanishi City Hospital, and written informed consent, we enrolled 27 patients scheduled for elective surgery...
June 2012: Masui. the Japanese Journal of Anesthesiology
Bryan Schloss, Julie Rice, Joseph D Tobias
BACKGROUND: Unintended hyperinflation of the cuff of a laryngeal mask airway (LMA) has been associated with increased airway morbidity and postoperative pain. While the manufacturers recommend a cuff pressure of less than 60 cmH(2)O, in usual clinical practice, there is no method used to determine intracuff pressure of an LMA. The purpose of this prospective quality assurance study is to evaluate the incidence of LMA hyperinflation and excessive intracuff pressure in a busy tertiary care pediatric hospital...
February 2012: International Journal of Pediatric Otorhinolaryngology
Hahck Soo Park, Jong In Han, Youn Jin Kim
BACKGROUND: This study examined whether changing the head position from neutral to side can affect expiratory tidal volume (TV) and cuff pressure when the appropriate sizes of a Proseal™ Laryngeal Mask Airway (PLMA)-depending on the body weight -are used in pediatric patients during pressure controlled ventilation (PCV). METHODS: Seventy-seven children (5-30 kg) were divided into three groups according to their body weight, PLMA#1.5 (group I, n = 24), #2 (group II, n = 26), and #2...
September 2011: Korean Journal of Anesthesiology
Lisen Hockings, Mairead Heaney, Neil A Chambers, Thomas O Erb, Britta S von Ungern-Sternberg
BACKGROUND: Optimal inflation of the laryngeal mask airway (LMA) cuff should allow ventilation with low leakage volumes and minimal airway morbidity. Manufacturer's recommendations vary, and clinical end-points have been shown to be associated with cuff hyperinflation and increased leak around the LMA. However, measurement of the intra-cuff pressure of the LMA is not routine in most pediatric institutions, and the optimal intra-cuff pressure in the LMA has not been determined in clinical studies...
April 2010: Paediatric Anaesthesia
Won-Jung Shin, Yu-Seon Cheong, Hong-Seuk Yang, Tomoki Nishiyama
BACKGROUND AND OBJECTIVE: The I-gel is a new single-use supraglottic airway device without an inflatable cuff. This study was designed to investigate the usefulness of the I-gel compared with the classic laryngeal mask airway (cLMA) and ProSeal laryngeal mask airway (pLMA) in anaesthetized, paralysed patients. METHODS: The American Society of Anesthesiologists physical status I-II patients (n = 167) scheduled for orthopaedic surgery were included in this prospective study...
July 2010: European Journal of Anaesthesiology
Britta S von Ungern-Sternberg, Thomas O Erb, Neil A Chambers, Mairead Heaney
BACKGROUND: Hyperinflation of the laryngeal mask airway (LMA) cuff is known to be a risk factor for airway morbidity and increased leakage around the LMA. While the manufacturers' recommendation is to inflate the cuff with the maximum recommended volumes and/or to adjust the cuff pressure to <60 cmH2O, cuff pressures below 40 cmH2O have been shown to be associated with a minimal rate of sore throat and minimal leakage. However, it remains to be determined whether inflation or deflation is needed to achieve favorable pressures...
September 2009: Paediatric Anaesthesia
Hwa-Yong Shin, Jung-Ae Lim, Seong-Hyop Kim, Seung-Woo Baek, Duk-Kyung Kim
PURPOSE: We hypothesized that the simultaneous use of low concentrations (<6%) of desflurane, nitrous oxide (N(2)O), and fentanyl would allow a laryngeal mask airway (LMA) to be inserted safely with inhalation induction of desflurane, even in nonparalyzed patients. This prospective, observational study was performed to determine the 50% effective concentration (EC(50)) of desflurane for LMA insertion in such patients. METHODS: Twenty-two adult patients undergoing ambulatory surgical procedures under general anesthesia using an LMA were included in the study...
2009: Journal of Anesthesia
C J Wallace, N A Chambers, T O Erb, B S von Ungern-Sternberg
Hyperinflation of the laryngeal mask airway cuff may exert high pressure on pharyngeal and laryngeal structures. In vitro data show that high intra cuff pressures may occur when inflated to only 30% of the manufacturer's recommended maximum inflation volume. We prospectively assessed the pressure volume curves of paediatric sized laryngeal mask airways (size 1-3) in 240 consecutive children (0-15 years). Following laryngeal mask airway insertion the cuff was inflated with 1-ml increments of air up to the maximum recommended by the manufacturer...
May 2009: Anaesthesia
Hideyuki Miyazaki, Takashi Asai, Tomoko Kambara, Atsushi Nagata, Koh Shingu
A 59-year-old man with cervical spondylosis was scheduled for a posterior spine surgery. After induction of anaesthesia with propofol and fentanyl, and neuromuscular blockade with vecuronium, the trachea was intubated using an 8.0-mm ID refinforced tube, without difficulty. After inflation of the cuff with 6 ml of air, there was no gas leak around the tube. The patient was placed in the prone position, and the head fixed to the operating table, using head pins. Several minutes later, there was a marked gas leak around the tracheal tube cuff...
February 2009: Masui. the Japanese Journal of Anesthesiology
Arnd Timmermann, Stefan Cremer, Christoph Eich, Stephan Kazmaier, Anselm Bräuer, Bernhard M Graf, Sebastian G Russo
BACKGROUND: In March 2007, a new disposable laryngeal mask airway (LMA) became available. The LMA Supreme (The Laryngeal Mask Company Limited, St. Helier, Jersey, Channel Islands) aims to combine the LMA Fastrach feature of easy insertion with the gastric access and high oropharyngeal leak pressures of the LMA ProSeal. METHODS: The authors performed an evaluative study with the LMA Supreme, size 4, on 100 women to measure the ease of insertion, determinate the laryngeal fit by fiberoptic classification, evaluate the oropharyngeal leak pressure, and report adverse events...
February 2009: Anesthesiology
Ana Licina, Neil A Chambers, Bruce Hullett, Thomas O Erb, Britta S von Ungern-Sternberg
BACKGROUND: Hyperinflation of laryngeal mask airway (LMA) cuffs may be harmful because of the exertion of high pressures on pharyngeal and laryngeal structures. Although cuff manometers may be used to monitor cuff pressure, their use is not routine in many institutions and clinical endpoints are used instead. Furthermore, it is common clinical practice to add air to the cuff in the presence of an air leak to obtain a better seal. METHODS: In a prospective audit, the authors assessed air leakage around pediatric sized LMAs (n = 200) following inflation guided by common clinical endpoints (slight outward movement of the LMA) and then following adjustment of the cuff pressure to the recommended pressure range (<60 cmH(2)O) according to institutional guidelines with the use of a calibrated cuff manometer, directly after induction of anesthesia...
October 2008: Paediatric Anaesthesia
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