Cricoid Pressure May Prevent Insertion of the Laryngeal Mask Airway

Ansermino, J. Mark; Blogg, C. E.

doi:10.1093/bja/69.5.465

Cited by 79 publications

(36 citation statements)

References 14 publications

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“…Previous studies on ProSeal (5) and classic LMA (12,14,15,18) report similar findings. Li et al (5) observed the anatomic position Scores 1 and 2 in 17/50 (34%) patients with CP compared to 38/50 (76%) patients after the release of CP.…”

Section: Discussionsupporting

confidence: 75%

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Clinical Evaluation of the Cricoid Pressure Effect on Bag Mask Ventilation, ProSeal Laryngeal Mask Airway Placement and Ventilation

Joshi¹,

Prakash

Mullick

et al. 2018

Turk J Anaesth Reanim

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Objective: Supraglottic airway devices can be life-saving in the 'cannot intubate, cannot oxygenate' situation. The cricoid pressure (CP) is considered critical in the prevention of aspiration. The aim of this self-controlled study was to evaluate the effect of CP on the bag mask ventilation (BMV), and the placement of and the ventilation through, the ProSeal laryngeal mask airway (LMA). Methods: In 60 adult patients undergoing elective surgery, after induction of anaesthesia, the effect of bimanual CP (≈30N) on BMV, ventilation through the ProSeal LMA, its anatomic position and airway seal pressures were evaluated. CP was released, the ProSeal LMA was reseated (appropriate position), the above assessments were repeated, and the effect of CP on the tidal volume (TV) and peak inspiratory pressure (PIP) was noted. Results: Out of 60 patients, the bag mask ventilation with CP was adequate in 25 (41.7%) patients compared to 59 (98.3%) patients without CP; p<0.001. The ventilation via the ProSeal LMA with CP was excellent, adequate and impossible in 0.0% (0), 49.2% (29) and 50.8% (30) patients, respectively, compared to 93.3% (56), 6.7% (4), 0% (0) patients, respectively, without CP; p<0.001. Releasing CP and advancing the ProSeal LMA to its appropriate position significantly improved the ventilation and anatomic position scores; both p<0.001. Airway seal pressures improved significantly without CP compared to with CP; p<0.001). With the ProSeal LMA in a proper position, the CP application resulted in a significant decrease in the mean expired TV (489.14±91.62 vs. 355.08±104.42 mL) with an increase in PIP (16.72±5.01 vs. 30.71±6.74 cmH2O); both p<0.001. Conclusion:The application of bimanual CP (≈30N) interferes with the bag mask ventilation and prevents both the correct placement and ventilation via the ProSeal LMA in adult patients. Keywords: Cricoid pressure, laryngeal mask airway, ProSeal, ventilation Amaç: Supraglottik havayolu cihazları entübe edilemeyen, oksijen verilemeyen durumlarda hayat kurtarıcı olabilirler. Krikoid bası-nın (KB) aspirasyonun önlenmesinde kritik öneme sahip olduğu düşünülmektedir. Bu öz-kontrollü çalışmanın amacı, KB'nin balon maske ventilasyon (BMV) ve ProSeal laringeal maske havayolu (LMA) yerleştirilmesi ve ventilasyonu üzerindeki etkisini değer-lendirmektir. Yöntemler: Bimanüel KB'nin (≈30N) BMV üzerindeki etkisi, ProSeal LMA ile ventilasyon, anatomik pozisyonu ve havayolu seal basınçları, elektif cerrahi geçiren 60 yetişkin hastada anestezi indüksiyonu sonrasında değerlendirildi. KB serbest bırakıldı, ProSeal LMA tekrar yerleştirildi (uygun pozisyon), yukarıda belirtilen değerlendirmeler tekrarlandı ve KB'nin tidal volüm (TV) ve tepe inspirasyon basıncı (PIP) üzerindeki etkisi kaydedildi. Bulgular: Altmış hastadan 25'inde (%41,7) KB ile balon maske ventilasyon, 59 (%98,3) hasta ile kıyaslandığında yeterliydi (p<0,001). KB olmadan uygulamaya maruz kalan sırasıyla %93,3 (56), %6,7 (4) ve %0 (0) hasta ile kıyaslandığında, KB ile ProSeal LMA yoluyla ventilasyon hastaların %0,0 (0), %49,2...

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Section: Discussionsupporting

confidence: 75%

“…Previous studies confirm impairment of ventilation via the classic LMA, when CP was applied prior to device insertion (12,14,15). Application of CP may cause laryngeal obstruction due to cricoid cartilage deformation or tilting resulting in a vocal cord closure (13).…”

Section: Discussionmentioning

confidence: 87%

Clinical Evaluation of the Cricoid Pressure Effect on Bag Mask Ventilation, ProSeal Laryngeal Mask Airway Placement and Ventilation

Joshi¹,

Prakash

Mullick

et al. 2018

Turk J Anaesth Reanim

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“…The LMA was subsequently inserted successfully in all the patients after removal of cricoid pressure. 22 These results are in direct conflict with those of previous studies 23' 24 that showed a failure rate of 3%.…”

Section: Discussionmentioning

confidence: 56%

The laryngeal mask airway in obstetrical anaesthesia

Gataure

Hughes

1995

Can J Anaesth

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The laryngeal mask airway (LMA) has been used extensively to provide a safe airway in spontaneously breathing patients who are not at risk from aspiration of gastric contents. The role of the LMA in the event of a failed intubation in an obstetrical patient, and its place in a failed intubation drill remains unclear. Two hundred and fifty consultant obstetric anaesthetists in the United Kingdom were asked to complete an anonymous questionnaire regarding their views about using the laryngeal mask airway (LMA) in obstetrical anaesthesia. The LMA was available in 91.4% of obstetric units. Seventy-two per cent of anaesthetists were in favour of using the LMA to maintain oxygenation when tracheal intubation had failed and ventilation using a face mask was inadequate. Twenty-four respondents had had personal experience with the LMA in obstetrical anaesthesia, eight of whom stated that the LMA had proved to be a lifesaver. We believe that the LMA has a role in obstetrical anaesthesia when tracheal intubation has failed and ventilation using a face mask proves to be impossible, and it should be inserted before attempting cricothyroidectomy.

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“…Successful LMA Classic ™ placement during cricoid pressure varies from a low of 15% 72,73 to a more encouraging 90%. 74 Overall, placement is more likely to be successful without cricoid pressure (92% vs. 66%).…”

Section: Third Approachmentioning

confidence: 99%

The LMA Classic™ as a conduit for tracheal intubation in adult patients: a review and practical guide

Alberts

2014

Southern African Journal of Anaesthesia and Analgesia

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Unexpected difficulty in maintaining an open airway following induction of anaesthesia remains an ever-present hazard. Repetitive attempts at direct laryngoscopy and intubation are generally acknowledged to be inappropriate. The LMA Classic ™ is recognised as a rescue ventilation device in failed intubation scenarios and its specific role is well defined in international airway management protocols. Should clinical conditions dictate the need for tracheal intubation following placement of an LMA Classic ™ , it may be retained to serve as a conduit for intubation. Utilising the LMA Classic ™ as a conduit for intubation is considered a rescue manoeuvre, only resorted to when conventional methods such as direct laryngoscopy have failed. Therefore, it is important that this approach to intubation has a high success rate and that airway management specialists are familiar with the different available options, the relevant limitations and the pitfalls. A short description of the components of the LMA Classic ™ , specifically relating to its function as an intubating conduit, is provided in this review. Its limitations as a conduit are then listed, followed by a description of the most popular techniques of intubation via the LMA Classic ™ . By adhering to a number of basic principles outlined in this review, limitations may be overcome, pitfalls avoided, and an escape conduit added for the anaesthetist who is faced with a difficult-to-intubate airway.

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Cricoid Pressure May Prevent Insertion of the Laryngeal Mask Airway

Cited by 79 publications

References 14 publications

Clinical Evaluation of the Cricoid Pressure Effect on Bag Mask Ventilation, ProSeal Laryngeal Mask Airway Placement and Ventilation

Clinical Evaluation of the Cricoid Pressure Effect on Bag Mask Ventilation, ProSeal Laryngeal Mask Airway Placement and Ventilation

The laryngeal mask airway in obstetrical anaesthesia

The LMA Classic™ as a conduit for tracheal intubation in adult patients: a review and practical guide

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