Impact of laryngeal mask airway cuff pressures on the incidence of sore throat in children

Wong, Justin Gin Leong; Heaney, Mairead; Chambers, Neil; Erb, Thomas O.; Ungern‐Sternberg, Britta S. von

doi:10.1111/j.1460-9592.2009.02968.x

Cited by 93 publications

(85 citation statements)

References 20 publications

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“…High cuff pressures in patients ventilated with LMA give rise to damage to the lingual, hypoglossal, and recurrent laryngeal nerves (5-7). Hyperinflation of an LMA cuff poses increased airway morbidity due to the pressure in the laryngeal as well as pharyngeal structures (8). Similarly, while an ETT cuff pressure higher than 48 cmH 2 O impedes capillary blood flow, a pressure lower than 18 mmHg increases the risk for aspiration of gastric contents (9).…”

Section: Discussionmentioning

confidence: 99%

The Professional Experience of Anaesthesiologists in Proper Inflation of Laryngeal Mask and Endotracheal Tube Cuff

Saraçoğlu¹,

Dal²,

Pehlivan³

et al. 2014

Turk J Anesth Reanim

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Objective: Cuffs inflated to inappropriately high pressures cause ischemia, reducing tracheal mucosal blood flow, while cuffs inflated at lower pressure than necessary give rise to inadequate ventilation, aspiration of gastric contents, or extubation due to air leakage. In this study, we aimed to investigate the effect of the experience of anaesthesia staff on endotracheal tube and laryngeal mask airway cuff inflation. Methods:The study included 348 elective patients scheduled to undergo surgery under general anaesthesia, with 34 anaesthesia technicians, 16 anaesthesia residents, and 12 anaesthesiologists with different years of professional experience. The participants were told to inflate the cuff balloon with air to the level of the pressure that was appropriate for them. No information was provided to the participants about the values of the cuff pressure pending the completion of all measurements. After placement of the laryngeal mask airway and endotracheal tube, the success of the procedure was checked by monitoring square-wave capnograph tracing and thoracoabdominal motion. Each participant performed the procedures on three patients, and the mean cuff pressures were measured. Results:There was no significant correlation between duration of experience of technicians, residents, and experts in using laryngeal mask airway pressure (r=-0.192/p=0.278, r=0.225/p=0.402, r=-0.476/p=0.118, respectively) and endotracheal tube (r=-0.306/ p=0.079, r=-0.060/p=0.826, r=-0.478/0.116, respectively). Conclusion:It has been concluded that professional experience does not contribute to achieving normal cuff pressure without monitoring. Introduction of the cuff manometer into routine anaesthesia practice will be useful, irrespective of anaesthesiologists' experience.

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Section: Discussionmentioning

confidence: 99%

The Professional Experience of Anaesthesiologists in Proper Inflation of Laryngeal Mask and Endotracheal Tube Cuff

Saraçoğlu¹,

Dal²,

Pehlivan³

et al. 2014

Turk J Anesth Reanim

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“…Sore throat is more likely with higher cuff pressures, and with the PVC as opposed to the silicone constructed LMA TM . 22 Rare adverse effects that appear related to cuff pressure and duration of use include lingual edema and neuropraxia of the lingual, hypoglossal, or recurrent laryngeal nerve. The incidence of complications with the flexible LMA TM and Proseal LMA TM appear similar to the LMA classic TM .…”

mentioning

confidence: 99%

“…Par rapport au LMA TM fait en silicone, les maux de gorge sont plus fréquents avec des pressions de ballonnet plus élevées et des dispositifs en PVC. 22 L'oedème lingual et la neuropraxie des nerfs lingual, grand hypoglosse et récurrent laryngé comptent parmi les effets secondaires rares apparaissant en relation avec la pression du ballonnet et la durée d'utilisation du dispositif. L'incidence de complications avec le LMA Flexible TM et le LMA Proseal TM est comparable à celle du LMA Classic TM .…”

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Supraglottic airways in children: past lessons, future directions

Cox

Lardner

2009

Can J Anesth/J Can Anesth

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The first prototype of the laryngeal mask airway (LMA TM ) was used clinically in the summer of 1981 at Ashford, Kent, UK, by Dr. Archie Brain. Dr. Brain followed in the worthy footsteps of Clover, O'Dwyer, Shipway, Leech, and others in developing a supraglottic airway to facilitate the delivery of anesthetic gases via a reliable supraglottic airway. 1 The LMA TM was released in the UK in 1988 and in the USA in 1992. Since the original range of pediatric LMAs TM was soon found to be inadequate to address all children's sizes, half-sizes (1.5 and 2.5) were developed. As with adult practice, the LMA TM and other supraglottic airways have radically changed pediatric anesthesia practice and have become a key component of airway management in children, both in the operating room and in remote anesthesia locations. These devices have increasingly been advocated for emergency airway control in the field, in the emergency department, and in the delivery suite. So what have we learned about pediatric supraglottic airways over the past two decades and where does the future lie with respect to these devices?Much of the published research in this area relates to the LMA Classic TM . From the clinical anesthesiologist's perspective, the following questions relating to the LMA Classic TM are important: When should it be used (patient and procedure related factors), how should it be used, and when should an alternative device be used?Indications for the use of the LMA Classic TM are extensive, and it is often the airway of choice in routine general anesthesia for minor procedures in children. In a prospective study of 1,400 children who had LMA TM -based anesthesia conducted by supervised trainees, the device was found to be highly effective for a broad range of surgical procedures, and there was no instance where the LMA TM had to be replaced with an endotracheal tube (ETT). 2 Initial misgivings about the use of the LMA TM for head and neck procedures were shown to be largely unfounded. For example, the LMA TM was shown to be safe and effective when used for ophthalmological surgery and adenotonsillectomy in children 3,4 ; however, these situations require a surgeon with some insight that the trachea is not intubated.Pediatric anesthesia is increasingly being delivered in areas outside the operating room where the LMA TM has been proven to be particularly valuable. For instance, the LMA TM has been used for radiotherapy, 5 magnetic resonance imaging, 6 fibreoptic bronchoscopy, 7 and upper gastrointestinal endoscopy. 8 Its relative stability combined with the ease of respiratory monitoring and the relative lack of airway complications are distinct advantages in these remote locations.One clinical scenario of particular interest is the difficult pediatric airway. Here the LMA TM has proven to be invaluable both as a rescue airway device in the child with a difficult airway and as a conduit for fibreoptic bronchoscopy and endotracheal intubation. 7 Consequently, the LMA TM has a role in both anticipated and unanticipated difficu...

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“…29 The literature also contains reports of more serious morbidity following over-inflation of ETT and LMA cuffs. 4,8,19,21,[30][31][32] Our data indicate a gap in anaesthetic training with the first step to changing clinical practice being a refocus on appropriate education.…”

Section: Resultsmentioning

confidence: 99%

“…This is a significant problem as hyperinflation of LMA and ETT cuffs can cause mucosal damage and subsequent oedema that may have a bigger impact on the smaller paediatric airway. 21 There seems to be an obvious gap in knowledge or education among anaesthetic practitioners. The current accepted recommended range for ETT cuff pressure is 20-30cmH 2 O 1 and the upper limit of safe LMA cuff pressures is considered to be 41cmH 2 O.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative management of ETT and LMA cuff pressures: a survey of anaesthetists’ knowledge, attitude and current practice

Castro

Gopalan

2016

Southern African Journal of Anaesthesia and Analgesia

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Background: Endotracheal tubes and laryngeal mask airway devices are routinely used during anaesthesia. Inappropriate inflation of cuffs has been shown to cause postoperative airway morbidity, and limiting the pressure decreases the incidence of pharyngo-laryngeal complications. Subjective measurements of cuff pressures correlate poorly to actual pressures, yet the use of objective cuff manometry is not routinely practised. The aim of this study was to determine current clinical practice of cuff inflation as well as the knowledge and attitude of anaesthetists in the University of KwaZulu-Natal (UKZN) Discipline of Anaesthesiology and Critical Care. Methods: This was a descriptive, observational study and data were collected using an anonymous self-administered questionnaire from practising anaesthetists in the UKZN Discipline of Anaesthesiology and Critical Care. Results: A total of 160 anaesthetists participated. The minimal occlusive volume test (38.8%) and the pilot balloon palpation technique (36.3%) were most commonly used. Most participants felt it was important to accurately measure ETT (84.8%) and LMA (56.1%) cuff pressures and that using a cuff manometer should be mandatory (76%). Reasons for not using it routinely included manometers not being readily available. Gaps in knowledge and education were also identified. Conclusion: There is increasing importance placed on quality assurance. Clinical practice varies widely among practitioners with the only consistency being the omission of cuff manometers during routine intraoperative management, despite their proven benefit and efficacy. The authors propose recommendations to facilitate the routine intraoperative use of cuff manometers.

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Impact of laryngeal mask airway cuff pressures on the incidence of sore throat in children

Abstract: We have demonstrated that intra cuff pressure in laryngeal mask airways is closely related to the development of sore throat with higher pressures increasing its likelihood. Hence, cuff pressures should be measured routinely using a manometer to minimize the incidence of sore throat.

Cited by 93 publications

References 20 publications

The Professional Experience of Anaesthesiologists in Proper Inflation of Laryngeal Mask and Endotracheal Tube Cuff

The Professional Experience of Anaesthesiologists in Proper Inflation of Laryngeal Mask and Endotracheal Tube Cuff

Supraglottic airways in children: past lessons, future directions

Intraoperative management of ETT and LMA cuff pressures: a survey of anaesthetists’ knowledge, attitude and current practice

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