scholarly journals Digital palpation of the pilot balloon vs. continuous manometry for controlling the intracuff pressure in laryngeal mask airways

Anaesthesia ◽  
2016 ◽  
Vol 71 (10) ◽  
pp. 1169-1176 ◽  
Author(s):  
M. Hensel ◽  
T. Güldenpfennig ◽  
A. Schmidt ◽  
M. Krumm ◽  
T. Kerner ◽  
...  
Keyword(s):  
Laryngeal Mask ◽  
Intracuff Pressure ◽  
Pilot Balloon ◽  
Digital Palpation

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 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.

scholarly journals Use of Manometry for Laryngeal Mask Airway Reduces Postoperative Pharyngolaryngeal Adverse Events

2010 ◽  
Vol 112 (3) ◽  
pp. 652-657 ◽  
Author(s):  
Edwin Seet ◽  
Farhanah Yousaf ◽  
Smita Gupta ◽  
Rajeev Subramanyam ◽  
David T. Wong ◽  
...  
Keyword(s):  
Laryngeal Mask Airway ◽  
Adverse Events ◽  
Group Versus ◽  
Routine Care ◽  
Laryngeal Mask ◽  
Care Group ◽  
Routine Practice ◽  
Number Needed To Treat ◽  
Intracuff Pressure ◽  
Usual Practice

Background Adverse events such as pharyngolaryngeal complications are indicators of quality patient care. Use of manometry to limit the laryngeal mask airway (LMA) intracuff pressure is not currently a routine practice. This double-blind randomized trial compared pharyngolaryngeal complications in patients managed with manometers to limit the LMA intracuff pressure (&lt;44 mmHg) with patients under routine care. Method Two hundred consenting patients who underwent ambulatory surgery were randomly allocated to pressure-limiting and routine care groups. Anesthesia was induced with propofol and fentanyl, and maintained with desflurane in air-oxygen. An LMA was inserted, and the cuff was inflated as per usual practice. The patients breathed spontaneously. Research assistants measured the LMA intracuff pressure. In the pressure-limiting group, LMA intracuff pressure was adjusted to less than 44 mmHg. No intervention was performed in the routine care group. Sore throat, dysphonia, and dysphagia were assessed at 1, 2, and 24 h postoperatively. Composite pharyngolaryngeal complications were compared using chi-square test. Results Baseline demographic data were comparable between groups. Mean LMA intracuff pressure was less in the pressure-limiting group versus the routine care group (40 +/- 6 vs. 114 +/- 57 mmHg, P &lt; 0.001). The incidence of composite pharyngolaryngeal complications was significantly lower in the pressure-limiting group versus the routine care group (13.4 vs. 45.6%, P &lt; 0.001), with a relative risk reduction of 70.6%, and a number needed to treat of three (95% CI 2.2-7.5). Conclusion Reduction of LMA intracuff pressure to less than 44 mmHg lowers the incidence of postoperative pharyngolaryngeal complications. The LMA cuff pressures should be measured routinely using manometry, and deflating the intracuff pressure to less than 44 mmHg should be recommended as anesthetic best practice.

scholarly journals Susceptibility of the pilot balloon of the disposable laryngeal mask airway to puncture during laser therapy

Anaesthesia ◽  
2012 ◽  
Vol 67 (5) ◽  
pp. 487-492
Author(s):  
A. Chilcott ◽  
T. S. Lister ◽  
P. M. Geary ◽  
P. A. Wright
Keyword(s):  
Laryngeal Mask Airway ◽  
Laser Therapy ◽  
Laryngeal Mask ◽  
Pilot Balloon

scholarly journals Effects of Head and Neck Position on Nasotracheal Tube Intracuff Pressure: A Prospective Observational Study

2021 ◽  
Vol 10 (17) ◽  
pp. 3910
Author(s):  
Hye Jin Kim ◽  
Jaewon Jang ◽  
So Yeon Kim ◽  
Wyun Kon Park ◽  
Hyun Joo Kim
Keyword(s):  
Head And Neck ◽  
Prospective Observational Study ◽  
Intracuff Pressure ◽  
Neutral Position ◽  
Pilot Balloon ◽  
Flexion Extension ◽  
Nasotracheal Tube ◽  
Head Flexion ◽  
Median Change ◽  
Head And Neck Position

To prevent endotracheal tube-related barotrauma or leakage, the intracuff pressure should be adjusted to 20–30 cm H2O. However, changes in the nasotracheal tube intracuff pressure relative to neck posture are unclear. In this study, we investigated the effect of head and neck positioning on nasotracheal tube intracuff pressure. Fifty adult patients with nasotracheal tubes who were scheduled for surgery under general anesthesia were enrolled. Following intubation, intracuff pressure was measured by connecting the pilot balloon to a device that continuously monitors the intracuff pressure. Subsequently, the intracuff pressure was set to 24.48 cm H2O (=18 mmHg) for the neutral position. We recorded the intracuff pressures based on the patients’ position during head flexion, extension, and rotation. The initial intracuff pressure was 42.2 cm H2O [29.6–73.1] in the neutral position. After pressure adjustment in the neutral position, the intracuff pressure was significantly different from the neutral to flexed (p < 0.001), extended (p = 0.003), or rotated (p < 0.001) positions. Although the median change in intracuff pressure was <3 cm H2O when each patient’s position was changed, overinflation to >30 cm H2O occurred in 12% of patients. Therefore, it is necessary to adjust the intracuff pressure after tracheal intubation and each positional change.

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.

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