Does the laryngeal mask airway compromise cricoid pressure?

Strang, Tim

doi:10.1111/j.1365-2044.1992.tb03138.x

Cited by 44 publications

(17 citation statements)

References 6 publications

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Section: Discussionmentioning

confidence: 99%

“…The maintenance of body temperature during major abdominal surgery is important as it may reduce blood loss and transfusion requirements, reduce time in recovery and be associated with lower overall anaesthetic costs [9]. In addition, since temperature is one of the criteria by which a patient is judged ready to extubate after surgery, patients undergoing aortic surgery who are normothermic at the end of surgery might be considered to be ready for extubation earlier than those who are hypothermic [10,11].The relatively long time spent in the anaesthetic room of 63 (14) min is worthy of comment, and reflects the fact that, being a teaching hospital, many of the intravascular lines, epidural and urinary catheters were inserted by anaesthetic trainees under supervision by consultants.The data presented in Fig. 2 suggest that the decrease in temperature of patients at the start of surgery is nonlinear, with a significant proportion of the overall decrease in temperature occurring early on.…”

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confidence: 99%

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Ease of tracheal intubation through the intubating laryngeal mask during manual in‐line head and neck stabilisation

2000

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SummaryWe have studied core temperature changes occurring during induction of general anaesthesia and surgery in 18 patients undergoing elective aortic aneurysm repair. In the operating theatre, all patients were warmed with a forced-air warmer and a warming mattress, and received warmed (37 ЊC) intravenous fluids. Despite this, mean (SD) [range] core temperatures in the anaesthetic room decreased by 1.5 (0.3)[1.1-2.2] ЊC, while intravascular lines, epidural and urinary catheters were inserted before the introduction of warming methods in theatre. In one-third of patients, the core temperature was still below 36 ЊC at the end of surgery. The overall temperature decrease correlated significantly with the duration of time between induction of general anaesthesia and surgical incision (R 2 0.6912), when the patients were not being warmed. Hypothermia may thus be prevented by minimising the period that the patient is anaesthetised without being warmed. Vascular lines, urinary and epidural catheters should be inserted before the induction of general anaesthesia or, alternatively, warming methods should be introduced in the anaesthetic room. Peri-operative hypothermia is common during major vascular surgery [1], due to factors such as redistribution of blood following induction of general anaesthesia, the abolition of central thermoregulatory mechanisms [2] and the administration of cold intravenous fluids. A patient undergoing aortic surgery is at particular risk of developing hypothermia as the abdomen may be open for a considerable time, there is a period of reduced perfusion of the lower body and fluid losses may be significant. Maintenance of body temperature peri-operatively is desirable as postoperative hypothermia has significant detrimental effects, including coagulopathy and blood loss [3], greater postoperative fluid requirements, increased need for vasopressors and inotropes, increased mortality [4], increased postoperative infection rate [5] and a higher incidence of myocardial ischaemia [6].Several different methods have been used to prevent peri-operative hypothermia [7], including the use of warmed intravenous fluids, forced-air warmers, warming mattresses, radiant heaters and the administration of heated and humidified anaesthetic gases. Of these, the most efficient is the forced-air warmer [8], the use of which has become routine in many institutions.At our hospital, all patients undergoing prolonged (b 2 h) surgery receive prophylactic warming measures in the operating theatre. These include the use of a forced-air warmer, a warming mattress and warmed intravenous fluids wherever possible. Despite this attention to warming techniques, patients undergoing aortic aneurysm repair still become hypothermic by 2 ЊC or more and often do not reach normothermia by the end of surgery, with the result that tracheal extubation may be delayed. We hypothesised that significant heat loss occurs in the anaesthetic room, after induction of anaesthesia and before the introduction of any of these warming methods. We...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Ease of tracheal intubation through the intubating laryngeal mask during manual in‐line head and neck stabilisation

2000

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“…If Heath and Allagain's intubation technique had failed, and the LMA had been left in position without effective cricoid pressure being applied, the LMA would probably have increased the likelihood of pulmonary aspiration of the gastric fluid [8]. Strang showed the effectiveness of cricoid pressure when used in conjunction with the LMA in cadavers [9]. Our experience supports his view and reinforces his warning that the LMA, used without cricoid pressure, will not prevent pulmonary aspiration of regurgitated material.…”

Section: Discussionmentioning

confidence: 99%

Emergency intubation through the laryngeal mask airway The effective application of cricoid pressure

Swayne

Greenslade

1994

Anaesthesia

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“…If cricoid pressure prevents insertion of a supraglottic airway, cricoid pressure is temporarily loosened during insertion, and once the device is inserted, the pressure should be reapplied. Cricoid pressure is effective if reapplied after insertion of the laryngeal mask [64], although it may cause a partial airway obstruction [65].…”

Section: Rapid-sequence Induction Of Anesthesiamentioning

confidence: 99%

Airway management in patients undergoing emergency Cesarean section

Asai

2015

J Anesth

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Special care is required for airway management of patients undergoing emergency Cesarean section. Although the incidence of difficult intubation and difficult ventilation is similar between pregnant and non-pregnant women, the severity of complications in pregnant patients would be much greater than in non-pregnant patients, if tracheal intubation is found to be difficult: increased risk of pulmonary aspiration, hypoxia, airway obstruction due to laryngeal edema, and a "sleeping baby" being taken out. Rapid-sequence induction of anesthesia is generally indicated to a patient undergoing emergency Cesarean section under general anesthesia. The technique has been evolving, without losing the key premise of minimizing the period of the airway being not protected from pulmonary aspiration, and of permitting rapid wake up if tracheal intubation fails. In this review, I describe the appropriate airway management, based on the current state of knowledge, in a patient undergoing emergency Cesarean section under general anesthesia.

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Does the laryngeal mask airway compromise cricoid pressure?

Cited by 44 publications

References 6 publications

Ease of tracheal intubation through the intubating laryngeal mask during manual in‐line head and neck stabilisation

Ease of tracheal intubation through the intubating laryngeal mask during manual in‐line head and neck stabilisation

Emergency intubation through the laryngeal mask airway The effective application of cricoid pressure

Airway management in patients undergoing emergency Cesarean section

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