Effect of laryngeal mask airway on esophageal motility during general anesthesia

Son, Young‐Ik; Park, Soo-Kyung; Cheong, Young-Pyo; Choi, Yoo-Sun; Ahn, Jeong Ho; Kim, Young-Hoon; Choi, Suck-Chei; Lee, Kyung-Kun

doi:10.1016/s0952-8180(02)00424-5

Cited by 9 publications

(6 citation statements)

References 21 publications

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“…However, from the clinical viewpoint this difference is negligible. Contrary to dogs in which the ratio between esophageal and airway pressure was better during positive occlusion test compared with standard occlusion test, probably because the esophagus is composed of entirely striated muscle, in humans the middle and distal esophageal body is mainly constituted by smooth muscle with a much lower influence of sedative drugs and neuromuscular blockers [ 22 – 25 ]. This was also confirmed by Hedenstierna et al [ 26 ] which showed no difference in the esophageal elastance (i.e., similar elasticity) between awake and anesthetized subjects.…”

Section: Discussionmentioning

confidence: 99%

The occlusion tests and end-expiratory esophageal pressure: measurements and comparison in controlled and assisted ventilation

Chiumello

Consonni

Coppola

et al. 2016

Ann. Intensive Care

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Background Esophageal pressure is used as a reliable surrogate of the pleural pressure. It is conventionally measured by an esophageal balloon placed in the lower part of the esophagus. To validate the correct position of the balloon, a positive pressure occlusion test by compressing the thorax during an end-expiratory pause or a Baydur test obtained by occluding the airway during an inspiratory effort is used. An acceptable catheter position is defined when the ratio between the changes in esophageal and airway pressure (∆Pes/∆Paw) is close to unity. Sedation and paralysis could affect the accuracy of esophageal pressure measurements. The aim of this study was to evaluate, in mechanically ventilated patients, the effects of paralysis, two different esophageal balloon positions and two PEEP levels on the ∆Pes/∆Paw ratio measured by the positive pressure occlusion and the Baydur tests and on the end-expiratory esophageal pressure and respiratory mechanics (lung and chest wall).MethodsTwenty-one intubated and mechanically ventilated patients (mean age 64.8 ± 14.0 years, body mass index 24.2 ± 4.3 kg/m2, PaO2/FiO2 319.4 ± 117.3 mmHg) were enrolled. In step 1, patients were sedated and paralyzed during volume-controlled ventilation, and in step 2, they were only sedated during pressure support ventilation. In each step, two esophageal balloon positions (middle and low, between 25–30 cm and 40–45 cm from the mouth) and two levels of PEEP (0 and 10 cmH2O) were applied. The ∆Pes/∆Paw ratio and end-expiratory esophageal pressure were evaluated.ResultsThe ∆Pes/∆Paw ratio was slightly higher (+0.11) with positive occlusion test compared with Baydur’s test. The level of PEEP and the esophageal balloon position did not affect this ratio. The ∆Pes and ∆Paw were significantly related to a correlation coefficient of r = 0.984 during the Baydur test and r = 0.909 in the positive occlusion test. End-expiratory esophageal pressure was significantly higher in sedated and paralyzed patients compared with sedated patients (+2.47 cmH2O) and when esophageal balloon was positioned in the low position (+2.26 cmH2O). The esophageal balloon position slightly influenced the lung elastance, while the PEEP reduced the chest wall elastance without affecting the lung and total respiratory system elastance.ConclusionsParalysis and balloon position did not clinically affect the measurement of the ∆Pes/∆Paw ratio, while they significantly increased the end-expiratory esophageal pressure.

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Section: Discussionmentioning

confidence: 99%

The occlusion tests and end-expiratory esophageal pressure: measurements and comparison in controlled and assisted ventilation

Chiumello

Consonni

Coppola

et al. 2016

Ann. Intensive Care

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“…Studies show decreased LES tone with the use of supraglottic airway device but no effect on the pharyngo-esophageal reflux [18,19]. The increase in IAP during LS may cause reflux of gastric contents with the risk of regurgitation or pulmonary aspiration [20].…”

Section: Pathophysiology Of Pneumoperitoneum and Anesthetic Concerns mentioning

confidence: 99%

Supraglottic Devices in Laparoscopic Surgery - A Review of Literature

Subramanian¹

2016

ACC

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“…Using LMA in children may be the last resort to obtain control of the airway. The literature shows that LMA does not provoke significantly different esophageal peristalsis compared with a ETT (7) and various surgical procedures can be performed using LMA. The main purpose of this case report is to show ability to ventilate a small infant with SLOS using a classic LMA# 1 and to perform a surgical procedure on the gastrointestinal tract without complications.…”

Section: Discussionmentioning

confidence: 99%

Airway management of patient with Smith–Lemli–Opitz syndrome for gastric surgery: case report

Matveevskii¹,

Berman

Sidi

et al. 2005

Pediatric Anesthesia

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A case of term, 5-day-old boy, with low birth weight of 2.4 kg, with Smith-Lemli-Opitz syndrome (SLOS) who was first scheduled for gastrostomy tube placement and later for pylorotomy, is discussed. General appearance of face and small chin showed possible difficulties during intubation, which are well known from the literature. Anesthetic plan included possibility of fiberoptic intubation. Mask induction and ventilation had been successful but attempts to intubate patient using fiberoptic bronchoscope had not been feasible and both procedures had been performed using laryngeal mask airway (LMA#1) with spontaneous ventilation without complications. In this case, we are showing the ability to secure the airway in a small infant with SLOS using LMA and the possibility to perform successfully surgery on the gastrointestinal tract.

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Effect of laryngeal mask airway on esophageal motility during general anesthesia

Cited by 9 publications

References 21 publications

The occlusion tests and end-expiratory esophageal pressure: measurements and comparison in controlled and assisted ventilation

The occlusion tests and end-expiratory esophageal pressure: measurements and comparison in controlled and assisted ventilation

Supraglottic Devices in Laparoscopic Surgery - A Review of Literature

Airway management of patient with Smith–Lemli–Opitz syndrome for gastric surgery: case report

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