Predictive risk factors of failed laryngeal mask airway insertion at first attempt

Wang, Jia; Shi, Xiao‐Ping; Xu, Tao; Wang, Geng

doi:10.1177/0300060518762666

Cited by 7 publications

(7 citation statements)

References 23 publications

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“…The physiological characteristics of the patient, such as male sex, advanced age, and high BMI, were associated with FLMA failure in our study, consistent with previous reports on non-ENT surgery [9,15]. Patients with a high BMI are likely to have larger pharyngeal fat pad areas [16], which leads to a decrease in the pharyngeal area.…”

Section: Plos Onesupporting

confidence: 89%

Safety, efficacy and airway complications of the flexible laryngeal mask airway in functional endoscopic sinus surgery: A retrospective study of 6661 patients

Shi

Cui

et al. 2021

PLoS ONE

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Objectives Although the flexible laryngeal mask airway (FLMA) provides considerable advantages in head and neck procedures, little is known about its safety and efficacy in functional endoscopic sinus surgery (FESS). We conducted a retrospective study to evaluate the success rate of FLMA and relevant airway complications in FESS under general anaesthesia. Methods A retrospective review of consecutive patients who underwent FESS for chronic rhinosinusitis was performed from 2015 to 2019. All patients scheduled for FLMA ventilation were identified. Patient characteristics, length of the surgery, FLMA size, failed FLMA cases requiring endotracheal intubation, immediate adverse airway events and delayed airway injuries were recorded. The primary outcomes included the FLMA success rate, which was defined as primary success after induction and final success after the whole surgical procedure. The secondary outcomes were specific clinical factors associated with FLMA failure and airway complications related to FLMA usage. Results Of the 6661 patients included in our study, primary success was achieved in 6572 (98.7%), and final success was achieved in 6512 (97.8%). Failure occurred in 89 patients (1.3%) during induction, in 14 (0.2%) during surgical preparation and in 46 (0.7%) during the intraoperative procedure. All patients with failed FLMA ventilation were successfully switched to endotracheal intubation. Male sex, advanced age, higher American Society of Anesthesiologists grade (ASA) and higher body mass index (BMI) were independent risk factors associated with failed FLMA. Immediate adverse respiratory events were observed in 0.85% of the patients, and delayed airway injuries associated with use of FLMA were observed in 0.07%. Conclusion This retrospective study demonstrates a high success rate for FLMA (97.8% in 6661 patients undergoing FESS). Adverse airway events and injuries associated with FLMA are rare, but clinicians should remain vigilant so that early diagnosis and prompt treatment can be provided.

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Section: Plos Onesupporting

confidence: 89%

Safety, efficacy and airway complications of the flexible laryngeal mask airway in functional endoscopic sinus surgery: A retrospective study of 6661 patients

Shi

Cui

et al. 2021

PLoS ONE

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“…A single operator performing PLMA insertions may have reduced this bias. Other factors not considered in this study were reduced mouth opening (inter-incisor distance <3 cm), higher Mallampati grade (III, IV), reduced neck mobility, age of >61 years, and BMI of <20 kg/m 2 , all of which could have also confound the successful placement of the PLMA ( 33 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

“…This may imply that the presence of adverse events, potentially leading to poor PLMA insertion conditions, may not necessarily hamper successful placement. The risk of failed LMA insertion has also been shown to increase with advanced age, high body weight, BMI <20 kg/m 2 and insertions without lignocaine gel ( 33 ).…”

Section: Discussionmentioning

confidence: 99%

Intravenous fentanyl vs. topical lignocaine for ProSeal™ laryngeal mask airway insertion with propofol induction

et al. 2022

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Insertion of the laryngeal mask airway (LMA) without muscle relaxant requires adequate obtundation of airway reflexes, which may otherwise lead to incorrect or failed LMA placement. This study compared topical lignocaine spray vs. intravenous (IV) fentanyl, during propofol induction for insertion of the ProSeal™ LMA (PLMA). This was a prospective, randomized, double blind study, in ASA I or II patients, for elective or emergency surgery. Seventy patients (n = 70) who fulfilled the inclusion criteria were randomly assigned to receive IV fentanyl 2 mcg/kg or topical lignocaine spray 40 mg, prior to anesthesia induction with IV propofol (2–2.5 mg/kg). ProSeal™ LMA insertion condition was regarded optimal in the absence of adverse responses (gag, cough, laryngospasm and body movements), and successful LMA placement at the first attempt. Hemodynamic parameters were recorded and patients were assessed for sore throat and hoarseness post operatively. Seventy patients were analyzed. The number of patients with optimal PLMA insertion conditions were comparable between the groups (60% vs. 57%, P = 0.808). All hemodynamic parameters were comparable between groups with the exception of heart rate. Sympathetic obtundation of heart rate was greater with IV fentanyl than topical lignocaine (P < 0.05). The proportion of patients with postoperative sore throat significantly increased with the number of insertion attempts (P < 0.05). Topical lignocaine spray to the pharynx is as effective, and may be an alternative to IV fentanyl, during propofol induction for PLMA insertion. Success rate and optimal insertion condition at the first attempt, propofol requirement, blood pressure, adverse events and airway complications were comparable. Heart rate obtundation was less with topical lignocaine spray but remained within clinically acceptable values.

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“…10 Repeated failed insertion attempts of the LMA might increase complications such as aspiration, edema, and bleeding. 11 Thus, different techniques such as single-handed cricoid pressure, bimanual cricoid pressure, rotation, and the triple airway maneuver have been studied to improve the first-pass success rates and the insertion times. [12][13][14][15] It was hypothesized that the jaw-thrust maneuver would ease the insertion of the LMA by moving the tongue forward from the palate and posterior pharyngeal wall.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Jaw-Thrust Maneuver and Standard Method for Airway Management with Laryngeal Mask Airway by Paramedics during Chest Compression: A Randomized, Crossover, Manikin Study

Özbek

Şancı

2022

Prehosp. Disaster med.

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Introduction: The first priority of the primary survey of trauma care is airway management. For patients who have a known or suspected cervical spine injury, using the jaw-thrust maneuver is critical. It was hypothesized that the jaw-thrust maneuver would ease the insertion of the laryngeal mask airway (LMA) by moving the tongue forward from the palate and posterior pharyngeal wall. Study Objectives: The aim of the study was to evaluate the effect of jaw-thrust maneuver on LMA insertion times of the paramedics with or without chest compression and with or without cervical stabilization in a manikin. Methods: Eleven experienced paramedics inserted LMA in jaw-thrust position and standard position in chest compression without cervical stabilization scenario, chest compression with cervical stabilization scenario, cervical stabilization without chest compression scenario, and the scenario where neither cervical stabilization nor chest compression were performed. The primary outcome of the study was the comparison of LMA insertion times for each method. The secondary outcome measures were first-pass success rates and the comparison of the difficulty level of each method. Results: During the LMA placement, performing the jaw-thrust maneuver instead of the standard method did not shorten the LMA insertion times. Adding chest compression and/or cervical stabilization did not complicate the LMA insertion. All of the LMA insertion attempts during the jaw-thrust maneuver and standard method were successful. Conclusion: The findings of this study suggest that LMA insertion might be attempted both during the jaw-thrust maneuver and standard position in patients with or without chest compression and with or without cervical stabilization.

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Predictive risk factors of failed laryngeal mask airway insertion at first attempt

Cited by 7 publications

References 23 publications

Safety, efficacy and airway complications of the flexible laryngeal mask airway in functional endoscopic sinus surgery: A retrospective study of 6661 patients

Safety, efficacy and airway complications of the flexible laryngeal mask airway in functional endoscopic sinus surgery: A retrospective study of 6661 patients

Intravenous fentanyl vs. topical lignocaine for ProSeal™ laryngeal mask airway insertion with propofol induction

Comparison of Jaw-Thrust Maneuver and Standard Method for Airway Management with Laryngeal Mask Airway by Paramedics during Chest Compression: A Randomized, Crossover, Manikin Study

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