Pharyngolaryngeal, Neck, and Jaw Discomfort after Anesthesia with the Face Mask and Laryngeal Mask Airway at High and Low Cuff Volumes in Males and Females

Brimacombe, J.; Holyoake, Lindsey; Keller, Christian; Brimacombe, Nick; Scully, M.; Barry, John J.; Talbutt, P; Sartain, J.; McMahon, Paul J.

doi:10.1097/00000542-200007000-00009

Cited by 145 publications

(115 citation statements)

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“…The insertion of an LMA may result in laryngeal injury such as oedema of the peripheral receptors of the afferent reflex arc [12]. Increased intracuff pressure, as well as the use of intermittent positive pressure ventilation, could affect laryngeal soft tissue [20,21], and Tanaka et al [12] have shown depression of defensive reflexes over a period of time when an LMA is in situ. However, the measurements in our study were performed immediately following induction of anaesthesia; care was taken to apply low cuff pressures [22] and all patients were breathing spontaneously.…”

Section: Discussionmentioning

confidence: 99%

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

et al. 2012

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SummaryWe studied the effect of intravenous lidocaine on laryngeal and respiratory reflex responses in children anaesthetised with sevoflurane. We tested the hypothesis that the incidence of laryngospasm evoked by laryngeal stimulation is temporarily diminished after the administration of lidocaine. Forty children, aged between 25 and 84 months, were anaesthetised with sevoflurane and breathed spontaneously through a laryngeal mask airway. Respiratory reflex responses were elicited by spraying distilled water onto the laryngeal mucosa at three time intervals: (i) before lidocaine was administered (baseline); (ii) at 2 min and (iii) at 10 min following the intravenous administration of a bolus of lidocaine 2 mg.kg )1 . A blinded reviewer assessed the evoked responses. The incidence of laryngospasm was reduced from 38% at baseline to 15% 2 min after lidocaine administration (p < 0.02) and 18% 10 min after lidocaine administration (p = 0.10). We conclude that intravenous lidocaine significantly reduced the incidence of laryngospasm but that the effect was short-lived. Protecting the lungs from aspiration is vitally important and is largely regulated by laryngeal and respiratory reflexes such as coughing, laryngospasm, expiration reflex, spasmodic panting and apnoea. However, exaggerated upper airway reflexes, particularly laryngospasm, have the potential to cause harm [1]. An increased incidence of laryngospasm and apnoea is observed in children compared with adults and complications resulting from hypoxaemia are more common and more severe in children [2][3][4]. Lidocaine has been demonstrated to reduce the incidence of laryngospasm in anaesthetised children [5,6]; however, its effectiveness has been questioned [7,8]. Uncertainty regarding its usefulness is partly explained by the fact that most clinical studies were underpowered to assess the relatively rare event of laryngospasm. Often more common adverse effects, such as stridor and the occurrence of hypoxaemia from whatever cause, were included in analyses assessing its incidence. Furthermore, studies examining the action of intravenous lidocaine on cough suppression during tracheal intubation revealed that the effect may only last a few minutes [9]. The potentially transient nature of this effect might make evaluation in the clinical setting difficult.

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Section: Discussionmentioning

confidence: 99%

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

et al. 2012

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“…79,80 Contributing factors include device type and size, insertion technique, and cuff pressure. [81][82][83][84][85] Proactive measurement and reduction of cuff pressures to Ͻ 60 cm H 2 O have been shown to reduce the incidence of sore throat. 82 Tongue congestion and edema may occur if the SAD is not inserted deeply enough or the cuff is overinflated.…”

Section: Airway Injurymentioning

confidence: 99%

Supraglottic Airway DevicesDiscussion

Ramachandran

Kumar

2014

Respir Care

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SummarySupraglottic airway devices (SADs) are used to keep the upper airway open to provide unobstructed ventilation. Early (first-generation) SADs rapidly replaced endotracheal intubation and face masks in > 40% of general anesthesia cases due to their versatility and ease of use. Second-generation devices have further improved efficacy and utility by incorporating design changes. Individual second-generation SADs have allowed more dependable positive-pressure ventilation, are made of disposable materials, have integrated bite blocks, are better able to act as conduits for tracheal tube placement, and have reduced risk of pulmonary aspiration of gastric contents. SADs now provide successful rescue ventilation in > 90% of patients in whom mask ventilation or tracheal intubation is found to be impossible. 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. Careful patient selection and excellent technical skills are necessary for successful use of these devices.

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“…However, inserting an upper airway device which would maintain airway patency while facilitating tracheal intubation seemed a safer approach than use of the fibrescope alone. Inserting a classic, or intubating laryngeal mask airway (cLMA, ILMA, Intavent Orthofix, Maidenhead, UK) might have been hindered by the acute angle between the oral cavity and the laryngopharynx [2] and several difficulties intubating through cLMAs have been described [3]. The correlation between a good fibreoptic laryngeal view through a ProSeal LMA (PLMA, Intavent Orthofix), and ease of gastric tube insertion through the PLMA's oesophageal port suggested that a PLMA might enable intubation if correctly positioned at the upper oesophageal sphincter [4].…”

Section: Use Of Proseal Laryngeal Mask Airway As a Dedicated Airway Fmentioning

confidence: 99%

“…Relocation was confirmed with an orthopantomogram. Use of a laryngeal mask airway predisposes to pharyngolaryngeal trauma [1], sore throat and dysphagia [2], but has not previously been reported to be associated with bilateral TMJ dislocation. There are, however, several reports of bilateral TMJ dislocation associated with anaesthesia [3,4].…”

Section: Use Of Proseal Laryngeal Mask Airway As a Dedicated Airway Fmentioning

confidence: 99%

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Use of ProSeal laryngeal mask airway as a dedicated airway for fibreoptic‐guided tracheal intubation

Cranshaw¹,

Shewry²

2006

Anaesthesia

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Pharyngolaryngeal, Neck, and Jaw Discomfort after Anesthesia with the Face Mask and Laryngeal Mask Airway at High and Low Cuff Volumes in Males and Females

Cited by 145 publications

References 0 publications

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

Supraglottic Airway DevicesDiscussion

Use of ProSeal laryngeal mask airway as a dedicated airway for fibreoptic‐guided tracheal intubation

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