Appropriate Size and Inflation of the Laryngeal Mask Airway

Howell, T. K.; Koga, Kazunori; Morris, Stephen

doi:10.1097/00132586-199904000-00055

Cited by 17 publications

(29 citation statements)

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“…Numerous authors have called for manometry to become routine in LMA insertion . Others advocate titrating LMA cuffs to achieve a ‘just seal’ pressure, as many of us routinely do with tracheal tubes . Other pragmatic suggestions include allowing the plunger of the 60‐ml inflating syringe to recoil, resulting in a pressure usually just less than 60 cmH 2 O .…”

Section: Resultsmentioning

confidence: 99%

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Fewer sore throats and a better seal: why routine manometry for laryngeal mask airways must become the standard of care

et al. 2014

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Section: Resultsmentioning

confidence: 99%

“…This may explain why, over an increasing range of inflation volumes, the airway seal pressure peaks around 15‐20 ml for a size‐4 LMA then progressively worsens with further inflation (see Fig. ) .…”

Section: Myth 3: Higher Volumes and Pressures May Cause Problems But mentioning

confidence: 98%

Fewer sore throats and a better seal: why routine manometry for laryngeal mask airways must become the standard of care

et al. 2014

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“…We chose to use size four and five masks and to inflate the cuffs to a volume less than the recommended maximum volume and nearer to the likely minimum effective volume to allow adequate ventilation. Recent studies [14, 18] and the manufacturer [13] recommend submaximal inflation volumes to provide the most effective seal. For the purposes of a training programme, it is important to give straightforward, didactic guidelines in terms of size and inflation volumes to help ensure retention of these details.…”

Section: Discussionmentioning

confidence: 99%

A comparison of the intubating and standard laryngeal mask airways for airway management by inexperienced personnel

Choyce¹,

Avidan

Shariff³

et al. 2001

Anaesthesia

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SummaryThis re-survey of neurosurgical centres was conducted to determine whether the publication of management guidelines has resulted in changes in the intensive care management of severely headinjured patients (defined as Glasgow Coma Score , 9) in the UK and Ireland. Results were compared with data collected from a similar survey conducted 2 years earlier. Almost 75% of centres monitor intracranial pressure in the majority of patients and 80% now set a target cerebral perfusion pressure of . 70 mmHg. The use of prolonged hyperventilation (. 12 h) is declining and the target P a co 2 is now most commonly . 4 kPa. More centres maintain core temperature , 36.5 8C. Although wide variations in the management of severely head-injured patients still exist, we found evidence of practice changing to comply with published guidelines. In surveys carried out 2 years ago, we highlighted the wide variation in the intensive care management of severely head-injured patients [defined as Glasgow Coma Score (GCS) , 9] in neurosurgical centres throughout the UK and Ireland [1, 2]. Since these initial surveys, two expert bodies have produced guidelines for the management of severe head injury [3, 4]. We surveyed neurosurgical centres to examine whether the management of severely head-injured patients had changed following publication of these guidelines. MethodsThe directors of 44 neurosurgical centres in the UK and Ireland were asked to complete a questionnaire identical to that used 2 years earlier. After 4 weeks, a copy of the questionnaire was sent to all non-responders with a covering letter urging them to reply. The data collected in this survey were compared with results obtained 2 years ago using a Chi-squared test. The significance level was set at 0.05 and statistical analysis was performed using statview 4.0 (Abacus Concepts Inc., Berkeley, CA, USA). ResultsAll 44 centres replied, but four of these did not treat severely head-injured patients and so were not analysed further. Compared with 1996, a greater proportion of units had dedicated junior staff (87 vs. 66%; Chisquared 13, d.f. 1, p , 0.05) and identifiable high-dependency unit (HDU) facilities (68 vs. 43%; Chi-squared 17, d.f. 1, p , 0.05). Only 54% of units had a written protocol for the management of raised intracranial pressure. The changes in management that we observed between the two survey periods are listed in Tables 1±3. DiscussionRecent guidelines [3, 4] suggest monitoring intracranial pressure (ICP) in all patients with a GCS , 9 or an abnormal computed tomography scan. Mean arterial pressure (MAP) should be maintained . 90 mmHg and cerebral perfusion pressure (CPP) . 70 mmHg. Intracranial hypertension should be treated when ICP is . 25 mmHg. The guidelines advise against severe or prolonged hyperventilation and found no evidence to support the use of steroids in head injury. The availability of these guidelines appears to have altered ICU care for severely head-injured patients.Organisational changes in admission practice, unit staffing and HDU bed...

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“…After loss of eyelash reflex, the patient’s head was positioned in a neutral position and the airway device inserted according to the manufacturer’s instructions. A size 4 (i‐gel and LMA‐U) was used for all patients, since it has been shown previously, that a gender based approach to laryngeal mask size selection is appropriate [6, 7]. Also, weight of the patients enrolled was well within the range recommended by both manufacturers for the use of size 4 devices.…”

Section: Methodsmentioning

confidence: 99%

A comparison of the i‐gel™ with the LMA‐Unique™ in non‐paralysed anaesthetised adult patients

et al. 2009

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SummaryThis study assessed two disposable devices; the newly developed supraglottic airway device i-gel TM and the LMA-Unique TM in routine clinical practice. Eighty patients (ASA 1-3) undergoing minor routine gynaecologic surgery were randomly allocated to have an i-gel (n = 40) or LMA-Unique (n = 40) inserted. Oxygen saturation, end-tidal carbon dioxide, tidal volume and peak airway pressure were recorded, as well as time of insertion, airway leak pressure, postoperative sore-throat, dysphonia and dysphagia for each device. Time of insertion was comparable with the i-gel and LMA-Unique. There was no failure in the i-gel group and one failure in the LMA-Unique group. Ventilation and oxygenation were similar between devices. Mean airway pressure was comparable with both devices, whereas airway leak pressure was significantly higher (p < 0.0001) in the i-gel group (mean 29 cmH 2 O, range 24-40) compared with the LMA-Unique group (mean 18 cmH 2 O, range 6-30). Fibreoptic score of the position of the devices was significantly better in the i-gel group. Post-operative sore-throat and dysphagia were comparable with both devices. Both devices appeared to be simple alternatives to secure the airway. Significantly higher airway leak pressure suggests that the i-gel may be advantageous in this respect.

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Appropriate Size and Inflation of the Laryngeal Mask Airway

Cited by 17 publications

References 0 publications

Fewer sore throats and a better seal: why routine manometry for laryngeal mask airways must become the standard of care

Fewer sore throats and a better seal: why routine manometry for laryngeal mask airways must become the standard of care

A comparison of the intubating and standard laryngeal mask airways for airway management by inexperienced personnel

A comparison of the i‐gel™ with the LMA‐Unique™ in non‐paralysed anaesthetised adult patients

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