Comparison of cuff-pressure changes in LMA-Classic® and the new Soft Seal® laryngeal masks during nitrous oxide anaesthesia in spontaneous breathing patients

Abstract

During nitrous oxide anaesthesia, cuff pressure increases in the LMA-Classic mask were significantly higher than those of the Soft Seal laryngeal mask. Trauma to patients, as assessed by the incidence of sore throat in the early postoperative period was significantly higher in the LMA-Classic group. Cuff pressures should be monitored during nitrous oxide anaesthesia when LMA-Classic is used but to do so is of less importance when using the disposable Soft Seal laryngeal mask.

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

“…After 30 years, we believe the evidence calls for a change in our practice. 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 .…”

“…Furthermore, nitrous oxide diffuses through silicone cuffs, e.g. that of the classic LMA, such that pressures rapidly exceed 60 cmH 2 O, regardless of initial inflation volumes .…”

Cuff filling volumes and pressures in pediatric laryngeal mask airways

“…Since cuff pressure monitoring is not routinely used by many anesthetists and as they may be unaware of the correct volume of air required, pressure induced airway morbidity is likely to occur. Increased cuff volumes and cuff pressures respectively have been described to result in increased incidence of sore throat and dysphagia by several authors (4,18–20).…”

Unilateral Hypoglossal Nerve Palsy after Use of the Laryngeal Mask Airway Supreme

“…Anand et al reported that intracuff pressure of LMA Supreme remained stable at approximately 60 cmH 2 O during an hour of nitrous oxide anesthesia [17]. Moreover, van Zundert et al suggested that continuous cuff monitoring can be omitted in pediatric LMA with a PVC cuff during nitrous oxide anesthesia [18]. Therefore, excessive cuff pressure due to nitrous oxide anesthesia might not be the main factor which caused the nerve injury in our case.…”