Pharyngolaryngeal Morbidity with the Laryngeal Mask Airway in Spontaneously Breathing Patients

Grady, Deirdre; McHardy, Fiona; Wong, Jean; Jin, Fengling; Tong, Doris; Chung, Frances

doi:10.1097/00000542-200105000-00012

Cited by 71 publications

(60 citation statements)

References 19 publications

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“…Selection of an appropriately sized device is important for safety and for securing an effective airway. Many studies have been conducted to determine the optimal sizes for the Classic TM LMA 15,16 and the PLMA. [8][9][10] Grady et al 15 suggested that a small LMA (size 4) decreases the incidence of sore throat in spontaneously breathing male patients.…”

Section: Discussionmentioning

confidence: 99%

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Insertion of the ProSeal™ laryngeal mask airway is more successful with the 90° rotation technique

Jeon

Park

et al. 2010

Can J Anesth/J Can Anesth

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Purpose The 90°rotation technique for inserting the ProSeal TM laryngeal mask airway (PLMA) in anesthetized paralyzed patients was compared with the index finger insertion technique. Methods One hundred twenty Asian adult patients were randomly allocated to either a standard technique group or a rotation technique group. A PLMA size 4 was used for women and size 5 was used for men. In the standard technique group (n = 60), the PLMA was inserted using the index finger. In the rotation technique group (n = 60), the entire cuff of the PLMA was placed in the patient's mouth in a midline approach without finger insertion, rotated 90°c ounter clockwise around the patient's tongue, advanced and then rotated back until resistance was felt. The primary outcome was success at first insertion. Secondary outcome measures were insertion time and complications. Results The success rate at first insertion was greater for the rotation technique group than for the standard technique group (100% vs 83%, respectively; P = 0.003), and less time was required (11 ± 3 sec vs 19 ± 16 sec, respectively; P = 0.03). The incidence of postoperative sore throat was lower for the rotation technique group than for the standard technique group (12% vs 33%, respectively; P = 0.009), and blood staining on the PLMA was less (8% vs 40%, respectively; P \ 0.001).Conclusion The 90°rotation technique for inserting the PLMA is more successful than the standard index finger insertion technique. It is associated with fewer side effects, such as blood on the PLMA and sore throat, which suggests it causes less pharyngeal trauma. (Clinical trial registration number: NCT00966186). RésuméObjectif La technique de rotation a`90°pour inse´rer le masque larynge´ProSeal TM (PLMA) chez des patients anesthe´sie´s curarise´s a éte´compare´e à la technique d'insertion avec l'index. Méthode Cent vingt patients adultes asiatiques ont e´teá le´atoirement re´partis en deux groupes, soit un groupe avec technique d'insertion standard et l'autre avec technique de rotation. Un masque PLMA de taille 4 a e´te´utilise´chez les femmes et un masque de taille 5 chez les hommes. Dans le groupe avec technique d'insertion standard (n = 60), le PLMA a e´te´inse´re´a`l'aide de l'index. Dans le groupe avec technique de rotation (n = 60), la manchette du PLMA a e´te´place´e en entier dans la bouche du patient a`l'aide d'une approche par ligne me´diane sans insertion de doigt, tourne´e de 90°dans le sens inverse des aiguilles d'une montre autour de la langue du patient, avance´e puis retourne´e jusqu'a`ressentir une re´sistance. Le crite`re d'e´valuation principal e´tait la re´ussite a`la premie`re insertion. Les crite`res d'e´valuation secondaires comprenaient le temps d'insertion et les complications. Résultats Le taux de re´ussite a`la premie`re insertion e´tait plus e´leve´dans le groupe avec technique de rotation que dans le groupe avec technique d'insertion standard (100 %

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Section: Discussionmentioning

confidence: 99%

“…They reported that a large LMA increased the risk of sore throat fourfold. 15 However, many investigators recommend routine use of a large size for general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Insertion of the ProSeal™ laryngeal mask airway is more successful with the 90° rotation technique

Jeon

Park

et al. 2010

Can J Anesth/J Can Anesth

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“…LMA-induced pharyngolaryngeal complications (POST, hoarseness, dysphagia) are related to the insertion technique, number of insertion attempts, LMA size, duration of anaesthesia and surgical position (11,(14)(15)(16). Studies have shown that the use of lubricants to facilitate insertion and cuff pressure control does not reduce the incidence of sore throat (2).…”

Section: Turk J Anaesth Reanim 2014; 42: 123-7mentioning

confidence: 99%

The Effect of Flurbiprofen on Postoperative Sore Throat and Hoarseness After LMA-ProSeal Insertion: A Randomised, Clinical Trial

Uztüre¹,

Menda²,

Bilgen³

et al. 2014

Turk J Anesth Reanim

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Objective: We hypothesized that flurbiprofen lozenges reduce the ProSeal laryngeal mask airway (LMA) related symptoms of Post Operative Sore Throat (POST), hoarseness and dysphagia compared to placebo lozenges.Methods: Eighty American Society of Anesthesiologists (ASA) I-II patients undergoing general anaesthesia with LMA were included in this prospective, randomized, placebo-controlled clinical and single centre (university hospital) study. Group F received an 8.75 mg flurbiprofen lozenge (Strefen ® ) and Group P received a placebo lozenge 45 minutes before the induction of anaesthesia. Postoperative sore throat, hoarseness and dysphagia were evaluated 30 minutes after removal of the LMA in the recovery room and then at 4, 12 and 24 h after surgery using a 4-point scale. Data were analysed using Student's t test, and Fisher's exact and Mann-Whitney U tests. A p value of <0.05 was considered statistically significant.Results: The 8.75 mg flurbiprofen lozenges reduced the severity of early (30 mins) POST and dysphagia. The severity of dysphagia at 4 h and hoarseness at 12 h were also significantly reduced in Group F. There were no significant differences betweeen the groups regarding incidence of sore throat, dysphagia and hoarseness throughout the study period.

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“…Devices with an inflatable cuff have the potential to cause tissue distortion, venous compression, and nerve injury, which explains the increased incidence of associated postoperative morbidity [4] Trauma on insertion, multiple insertions, and pressure exerted by cuff against the pharyngeal mucosa, [21,22] cuff volumes [23] and pressure [24] have all been incriminated for postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Can i-gel Replace Endotracheal Tube during Elective Cesarean Section?

Amin¹,

Fathy²

2016

J Anesth Clin Res

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Pharyngolaryngeal Morbidity with the Laryngeal Mask Airway in Spontaneously Breathing Patients

Abstract: Selection of a small laryngeal mask airway (size 4) in spontaneously breathing male patients may be more appropriate to limit the occurrence of sore throat on the first postoperative day. All patients had a fourfold increased risk of developing sore throat when a large LMA was used.

Cited by 71 publications

References 19 publications

Insertion of the ProSeal™ laryngeal mask airway is more successful with the 90° rotation technique

Insertion of the ProSeal™ laryngeal mask airway is more successful with the 90° rotation technique

The Effect of Flurbiprofen on Postoperative Sore Throat and Hoarseness After LMA-ProSeal Insertion: A Randomised, Clinical Trial

Can i-gel Replace Endotracheal Tube during Elective Cesarean Section?

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