Severity of airway hyperreactivity associated with laryngeal mask airway removal: correlation with volatile anesthetic choice and depth of anesthesia

Pappas, Ana Lucia; Sukhani, Radha; Lurie, Jordan; Pawlowski, Julius; Sawicki, Kristina; Corsino, Andrea

doi:10.1016/s0952-8180(01)00318-x

Cited by 48 publications

(48 citation statements)

References 15 publications

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“…Central to the issue of adequate timing of LMA removal is the specific definition of "anesthetic state" and "awake state." Previous studies used various depths of anesthesia, such as surgical plane of anesthesia [11] or 2 minimum alveolar concentration (MAC) of a volatile anesthetic agent [2,3,12]. Some studies had no specific guidelines regarding anesthetic depth [5,7,13].…”

Section: Discussionmentioning

confidence: 99%

“…Most previous studies included participants form less than 1 year to more than 13 years of age [2][3][4][5][6][7]11,12]. The airway reflex may be affected by growth, as children have a more irritable airway than adults [14].…”

Section: Discussionmentioning

confidence: 99%

“…Concomitant administration of other commonly used drugs such as fentanyl, morphine, and 2% lidocaine jelly may affect the airway reflex [2,10,12]. Although these drugs are commonly used in clinical situations, they may produce bias because of their effect on the depth of anesthesia and the upper airway reflex.…”

Section: Discussionmentioning

confidence: 99%

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A randomized controlled trial comparing Laryngeal Mask Airway removal during adequate anesthesia and after awakening in children aged 2 to 6 years

Park

Kim

et al. 2012

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A randomized controlled trial comparing Laryngeal Mask Airway removal during adequate anesthesia and after awakening in children aged 2 to 6 years

Park

Kim

et al. 2012

Journal of Clinical Anesthesia

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“…Early return of protective airway reflexes after cLMA removal decreases the risk of aspiration, contamination, or airway obstruction. So low blood gas solubility of agents like sevoflurane [6] and desflurane [7] make them ideal agents for cLMA removal during deep anaesthesia.…”

mentioning

confidence: 99%

ED50 of desflurane for laryngeal mask airway removal in anaesthetised adults

Makkar

Sakshi

Jain³

et al. 2011

Anaesthesia

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SummaryPrevious estimates for the end-tidal concentration of desflurane that allows removal of the laryngeal mask airway in 50% of anaesthetised adults (ED50) have ranged from 2.1% to 5.3%. To assess which value is correct, we studied 32 female patients (aged 30-50 years) undergoing intracavity caesium implants for cervical carcinoma under general anaesthesia. Anaesthesia was induced with propofol 2-3 mg.kg )1 and maintained with desflurane in a 50% nitrous oxideoxygen mixture. At the end of surgery, a predetermined target end-tidal desflurane concentration (starting at 4%) was maintained for 10 min using Dixon's up-down method and the laryngeal mask airway was removed. The target end-tidal concentration in the next patient was increased or decreased by 0.5% depending upon the response of the previous patient. Removal of the laryngeal mask airway without coughing, clenching, biting, movement or any adverse airway event during or within 1 min after removal was considered to be successful. We found that the laryngeal mask airway can be successfully removed in 50% (ED50) and 95% (ED95) of the anaesthetised adults at end-tidal desflurane concentrations of 2.4% (95% CI 1.3-2.9) and 3.8% (3.1-9.6), respectively.

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“…This is due to the respiratory tract irritation caused by these inhalational anesthetics. Sevofl urane is suitable for anesthesia induction by volatile anesthetic [133]. The bronchodilator effects of isofl urane and sevofl urane are more prominent in the peripheral airways than in the central airways [134], and these effects can be useful in COPD with peripheral airway involvement.…”

Section: Choice Of Anestheticsmentioning

confidence: 99%

Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease

2008

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Increased airway hyperresponsiveness is a major concern in the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease. Guidelines using evidence-based medicine are continually being updated and published regarding the diagnosis, treatment, and prevention of these respiratory disorders. Perioperative management in these patients involves: (1) adequate control of airway hyperresponsiveness, including detection of purulent sputum and infection before surgery; (2) evidence-based control of anesthesia; and (3) the aggressive use of beta-2 adrenergic stimulants and the systemic administration of steroids for the treatment of acute attacks. Good preoperative control, including the use of leukotriene antagonists, can reduce the incidence of life-threatening perioperative complications. Awareness of recent guidelines is thus important in the management of patients with airway hyperresponsiveness. This review covers the most recent guidelines for the perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease.

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Severity of airway hyperreactivity associated with laryngeal mask airway removal: correlation with volatile anesthetic choice and depth of anesthesia

Cited by 48 publications

References 15 publications

A randomized controlled trial comparing Laryngeal Mask Airway removal during adequate anesthesia and after awakening in children aged 2 to 6 years

A randomized controlled trial comparing Laryngeal Mask Airway removal during adequate anesthesia and after awakening in children aged 2 to 6 years

ED50 of desflurane for laryngeal mask airway removal in anaesthetised adults

Guideline-oriented perioperative management of patients with bronchial asthma and chronic obstructive pulmonary disease

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