Effect of diffusion of anaesthetic gases on fibre-optic view change of laryngeal mask airway and post-operative laryngo-pharyngeal morbidity in children – A randomised controlled trial

Abstract

Background and Aims: The diffusion of nitrous oxide (N 2 O) into the air-filled cuff of the classic laryngeal mask airway (LMA) may lead to an increase in cuff pressure (CP) and displacement of LMA affecting its performance. This study was conducted to evaluate the change in optimal position of LMA by fibre-optic bronchoscope, the changes in cuff pressure and oropharyngeal leak pressure (OLP), and post-operative laryngo-pharyngeal morbidity during N 2 O–oxygen (O 2 ) anaesthesia in children. Methods: After ethics committee approval and written informed consent, 84 children, aged 2 to 8 years undergoing lower abdominal surgery using LMA were included. Anaesthesia was induced with sevoflurane and maintained with either 33% O 2 in air (Group 1) or with 33% O 2 in 67% N 2 O (Group 2) along with sevoflurane. The position of LMA using fibre-optic bronchoscope, CP and OLP were recorded at 30, 60 and 90 minutes and at the end of surgery. The incidence of post-operative sore throat, hoarseness of voice and dysphagia was assessed for 24 hours. Results: A mild (Grade 1) change in fibre-optic position of LMA was observed in 6 out of 42 children maintained with N 2 O–O 2 anaesthesia. The cuff pressure was higher than baseline in group 2 at all three time points with the maximum at 90 minutes (93.23 ± 14.86 cm H 2 O vs. 39.78 ± 7.75 cm H 2 O; P < 0.05). The OLP was comparable between the groups during the initial 60 minutes and then increased in group 2. The incidence of post-operative sore throat was significantly higher in group 2 ( P = 0.008). Conclusion: The diffusion of anaesthetic gases into the air-filled cuff does not change the fibre-optic position of the LMA significantly but increases the cuff pressure and incidence of post-operative laryngo-pharyngeal complications in children.

Bronchial blocker through Proseal LMA – A useful approach for paediatric lung isolation

“…PLMA has been used successfully in the lateral position with minimal dislodgement rates. [ 4 5 ] However, the oropharyngeal sealing pressure of PLMA can decrease in the lateral position in children. [ 6 ] In an event of dislodgement, rescue measures should include deepening the plane of anaesthesia, repositioning of LMA, and if not successful, LMA may be removed and ET can be passed with BB in situ.…”