Effect of the Laryngeal Mask Airway on Lower Oesophageal Sphincter Pressure in Patients During General Anaesthesia

Rabey, P.G.; Murphy, Paul; Langton, Josephine; Barker, P.; Rowbotham, David J.

doi:10.1093/bja/69.4.346

Cited by 141 publications

(55 citation statements)

References 9 publications

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“…8 However, some concerns with these devices remain, including failing to adequately ventilate, causing airway damage, and increasing the likelihood of pulmonary aspiration of gastric contents. 9,10 Careful patient selection and excellent technical skills are necessary for successful use of these devices. 8 The I-gel and SLMA are second-generation SADs for use during anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

Comparative study between LMA supreme with I-gel in anaesthetised adult patient on effectiveness and safety

Samel

Morale

2017

Int J Res Med Sci

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Background: Supreme laryngeal mask airway (SLMA) and I-gel airway devices are second generation supraglottic airway devices (SAD) and are good alternatives to intubation during surgeries. The study was conducted with the objective to compare two supraglottic airway devices for ease of insertion, number of attempts of insertion, hemodynamic changes, incidence of adverse effects like regurgitation, lip and dental trauma and post-operative sore throat, dysphagia or hoarseness. Methods: This study was conducted at Topiwala National Medical College and BYL Nair hospital, Mumbai. 80 patients of ASA class 1 and 2 with Mallampati grading 1 and 2, between age group of 18-60 years and with BMI <28kg/m 2 were selected for the study. After induction of anesthesia for all the patients, one of SAD (SLMA or I-gel) was inserted randomly and accordingly they are divided into two groups consisting of 40 in each. Insertion parameters, hemodynamic and respiratory parameters were noted. Patients were also observed for any complications for 1 hour and 24 hours postoperatively. Results: Both groups were compared in terms of demographic characteristics, insertion parameters, hemodynamic and respiratory parameters and found no statistically significant differences between them (p>0.05). Postoperatively no significant complications were observed in terms of dental injury, laryngospasm. Complication like sore throat after 1 hour and after 24 hours was comparatively more in I-gel group but difference was not significant at 1 hr (p>0.05). Dysphagia was reported more in SLMA group (8 cases) than I-gel group (1 case) at one hour and the difference was statistically significant (p=0.013). Conclusions: SLMA and I-GEL are better airway management option for patients undergoing short surgical procedures under general anaesthesia.Keywords: Efficacy, I-gel, Safety, Supraglottic airway devices, SLMA DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175437Samel SA et al. Int J Res Med Sci. 2017 Dec;5(12):5263-5267 International Journal of Research in Medical Sciences | December 2017 | Vol 5 | Issue 12 Page 5264 seal pressure around the laryngeal opening. It has integral bite block and a tab for adhesive fixation of the device. Fixation tab is rectangular structure moulded on to the manifold at right angles and projects over the patient's upper lip. It is designed to facilitate easy insertion and fixation of the SLMA, after insertion and inflation of its cuff. 3 The I-gel is a truly unique latex free SAD. The shape, softness and contours accurately mirror the peri-laryngeal anatomy to create the perfect fit and no cuff inflation is required. I-Gel provides controlled ventilation and spontaneous breathing during anaesthesia and it allows easy recognition of gastric content and passage of drain tube and suctioning and venting. 4 Many studies have been conducted regarding the safety and efficacy of SLMA and I-gel in various situations. [4][5][6][7] But still there is a need to prove their safety and efficiency in short surgical procedures. Henc...

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Section: Discussionmentioning

confidence: 99%

Comparative study between LMA supreme with I-gel in anaesthetised adult patient on effectiveness and safety

Samel

Morale

2017

Int J Res Med Sci

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“…Therefore, it is possible that the degree of stretching of the upper oesophageal sphincter was lower in our patients than in those of the previous studies in whom the cuff might have been inflated with a maximum volume of air. Stretching of the upper oesophageal sphincter is known to dilate the lower oesophageal sphincter and increases the incidence of regurgitation [20].…”

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confidence: 99%

Timing of removal of the laryngeal mask airway

et al. 1998

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SummaryPrevious studies reported that complications associated with removal of the laryngeal mask were more frequent in awake patients than in anaesthetised patients; however, these studies did not comply with the method described in the manufacturer's instruction manual. The reported incidences of regurgitation during the use of the laryngeal mask also differ considerably between studies. We studied these factors in 66 patients in whom the method described in the manual was used. After induction of anaesthesia, the laryngeal mask and a pH probe were inserted and the cuff of the mask was inflated with a minimum volume of air. Anaesthesia was maintained with nitrous oxide and isoflurane in oxygen. At the end of the operation, we randomly allocated patients to one of two groups and the laryngeal mask was removed either while they were still deeply anaesthetised or after they had regained consciousness. No apparent regurgitation occurred in any patient during operation, but one patient in the anaesthetised group regurgitated immediately after removal of the mask. The incidence of complications during or after removal of the laryngeal mask was significantly greater in the anaesthetised group than that in the awake group (p << 0.001; difference [95% CI]: 48.5 [30.5-66.5]%). Therefore, the laryngeal mask can be safely left in place until the patient has regained consciousness after emergence from anaesthesia.

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“…The studies to date on the effect of the LMA on the incidence of the regurgitation show conflicting resuits. [3][4][5] In this context, given our present state of knowledge, we would be cautious in recommending the use of the LMA in view of the potential for regurgitation. Furthermore, since the tip of the LMA lies below the level of the cricoid cartilage when the LMA is properly positioned, application of cricoid pressure hampers correct positioning of the LMA.…”

Section: Lma For Failed Intubation (2)mentioning

confidence: 99%

LMA for failed intubation (1)

Levy

1993

Can J Anaesth

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Effect of the Laryngeal Mask Airway on Lower Oesophageal Sphincter Pressure in Patients During General Anaesthesia

Abstract: SUMMARYWe have studied the tone of the lower oesophageal sphincter (LOS)

Cited by 141 publications

References 9 publications

Comparative study between LMA supreme with I-gel in anaesthetised adult patient on effectiveness and safety

Comparative study between LMA supreme with I-gel in anaesthetised adult patient on effectiveness and safety

Timing of removal of the laryngeal mask airway

LMA for failed intubation (1)

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