Randomized crossover study assessing oropharyngeal leak pressure and fiber optic positioning

Gasteiger, Lukas; Ofner, Sigrid; Stögermüller, Birgit; Ziegler, Bernhard; Brimacombe, J.; Keller, Christian

doi:10.1007/s00101-016-0192-1

Cited by 8 publications

(4 citation statements)

References 15 publications

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“…Recently, it was suggested that the actual tightness of the inserted LMA, rather than fiberoptic view, is an important parameter of adequate airway management [1]. As a mean of this evaluation, an airway sealing pressure or OPLP is commonly performed with the supraglottic airway to quantify the seal with the airway and judge the appropriateness of ventilation [1, 7–12]. OPLP values have been widely used as a reference for feasibility of positive pressure ventilation and the degree of airway protection and is regarded as the most important value when testing the stability of a LMA [9].…”

Section: Discussionmentioning

confidence: 99%

“…The variety of cuff’s properties and shapes of supraglottic airway should be considered. Fourthly, we did not use muscle relaxants before insertion of the LMA, because the LMA can be inserted easily without muscle relaxants if an adequate depth of anaesthesia is reached [9, 12]. Because there is some evidence suggesting that the use of neuromuscular blocker can alter the OPLP [22], this should be considered.…”

Section: Discussionmentioning

confidence: 99%

“…OPLP is commonly measured during LMA insertion to evaluate the degree of airway protection. High OPLPs are desirable as they indicate the feasibility of positive pressure ventilation and the likelihood of successful supraglottic airway placement [1, 7–12]. However, so far, no study has evaluated the efficacy of laryngoscope-guided LMA insertion techniques using OPLP as an indicator.…”

Section: Introductionmentioning

confidence: 99%

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Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion

Kim

et al. 2019

BMC Anesthesiol

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BackgroundInsertion under laryngoscopic guidance has been used to achieve ideal positioning of the laryngeal mask airway (LMA). However, to date, the efficacy of this technique has been evaluated only using fiberoptic evaluation, and the results have been conflicting. Other reliable tests to evaluate the efficacy of this technique have not been established. Recently, it has been suggested that the accuracy of LMA placement can be determined by clinical signs such as oropharyngeal leak pressure (OPLP). The aim of this study was to assess the efficacy of LMA insertion under laryngoscopic guidance using OPLP as an indicator.MethodsAfter approved by the institutional ethics committee, a prospective comparison of 100 patients divided into 2 groups (50 with blind technique and 50 with the laryngoscope technique) were evaluated. An LMA (LarySeal™, Flexicare medical Ltd., UK) was inserted using the blind approach in the blind insertion group and using laryngoscopy in the laryngoscope-guided insertion group. The OPLP, fiberoptic position score, whether the first attempt at LMA insertion was successful, time taken for insertion, ease of LMA insertion, and adverse airway events were recorded.ResultsData were presented as mean ± standard deviation. The OPLP was higher in the laryngoscope-guided insertion group than in the blind insertion group (21.4 ± 8.6 cmH2O vs. 18.1 ± 6.1 cmH2O, p = 0.031). The fiberoptic position score, rate of success in the first attempt, ease of insertion, and pharyngolaryngeal adverse events were similar between both groups. The time taken for insertion of the LMA was significantly longer in the laryngoscope-guided insertion group, compared to blind insertion group (35.9 ± 9.5 s vs. 28.7 ± 9.5 s, p < 0.0001).ConclusionLaryngoscope-guided insertion of LMA improves the airway seal pressure compared to blind insertion. Our result suggests that it may be a useful technique for LMA insertion.Trial registrationcris.nih.go.kr, identifier: KCT0001945 (2016-06-17).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion

Kim

et al. 2019

BMC Anesthesiol

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“…Kumar CM et al pointed out that the accuracy of LMA placement can be determined by clinical signs such as oropharyngeal sealing pressure [ 12 ]. High oropharyngeal sealing pressure are desirable as they indicate the feasibility of positive pressure ventilation and the likelihood of successful supraglottic airway placement [ 10 , 13 , 15 – 19 ]. The SaCoVLM™ can observe glottic exposure due to its visual function, and can optimize glottic exposure by using the up-down manoeuvre.…”

Section: Discussionmentioning

confidence: 99%

To compare the influence of blind insertion and up-down optimized glottic exposure manoeuvre on oropharyngeal leak pressure using SaCoVLM™ video laryngeal mask among patients undergoing general anesthesia

Yan

Zhang

Chen

et al. 2022

J Clin Monit Comput

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To compare the potential influences of blind insertion and up-down optimized glottic exposure manoeuvre on the oropharyngeal leak pressure (OPLP) in using SaCoVLM™ video laryngeal mask (VLM) among patients undergoing general anesthesia. A randomized self-control study controlled was conducted to investigate the effect of two insertion techniques on OPLP. A total of 60 patients (male or female, 18–78 years, BMI 18.0–30.0 kg m−2 and ASA I–II) receiving selective surgery under general anesthesia were randomly recruited. After induction of anesthesia, the SaCoVLM™ was inserted by blind insertion manoeuvre. The glottic exposure grading(V1) of the SaCoVLM™ visual laryngeal mask and the OPLP(P1) were recorded. And the glottic exposure grading(V2) and OPLP(P2) of SaCoVLM™ were recorded again when the glottic exposure grading was optimal. The glottis exposure grading and OPLP were compared before and after different insertion manoeuver. The glottic exposure grading (V2) obtained by using up-down optimized glottic exposure manoeuvre was better than that obtained by using blind insertion manoeuvre (V1)(P < 0.001). The OPLP was significantly lower in the blind insertion manoeuvre (P1) than in the up-down optimized glottic exposure manoeuvre (P2) (32.4 ± 5.0 cmH2O vs. 36.3 ± 5.2 cmH2O, P < 0.001). In using SaCoVLM™, higher OPLP and better glottic exposure grading were achieved through up-down optimized glottic exposure manoeuvre, protecting the airway while real-time monitoring of conditions around the glottis, which significantly improves airway safety. Our results suggests that up-down optimized glottic exposure manoeuver may be a useful technique for SaCoVLM™ insertion.Trial registration: ChiCTR, ChiCTR2000028802. Registered 4 January 2020, http://www.chictr.org.cn/ChiCTR2000028802.

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Update 2022: Interdisziplinäre Stellungnahme zum Atemwegsmanagement mit supraglottischen Atemwegshilfen in der Kindernotfallmedizin – die Larynxmaske ist und bleibt State of the Art

et al. 2023

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Randomized crossover study assessing oropharyngeal leak pressure and fiber optic positioning

Abstract: We conclude that oropharyngeal leak pressure, fiber optic position, first attempt insertion success rate and bloodstaining differed between the LMA Supreme™ and the LTS II™ in children.

Cited by 8 publications

References 15 publications

Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion

Conditions for laryngeal mask airway placement in terms of oropharyngeal leak pressure: a comparison between blind insertion and laryngoscope-guided insertion

To compare the influence of blind insertion and up-down optimized glottic exposure manoeuvre on oropharyngeal leak pressure using SaCoVLM™ video laryngeal mask among patients undergoing general anesthesia

Update 2022: Interdisziplinäre Stellungnahme zum Atemwegsmanagement mit supraglottischen Atemwegshilfen in der Kindernotfallmedizin – die Larynxmaske ist und bleibt State of the Art

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