The effect of nitrous oxide on intracuff pressure of the size 2 ProSeal Laryngeal Mask Airway

Chen, Ben-zhen; Luo, Lihui; Lü, Jing; Wang, Rurong; Li, Jingxia; Tan, Ling

doi:10.1016/j.jclinane.2010.09.004

Cited by 12 publications

(7 citation statements)

References 22 publications

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“…It has been suggested that, particularly for the smaller sizes, SADs should be deflated following insertion, rather than inflated, in order to avoid cuff hyperinflation . The use of nitrous oxide significantly increases cuff pressures and, in one study, the incidence of postoperative sore throat was 45% compared with 5% in the group receiving air .…”

Section: Methodsmentioning

confidence: 99%

“…Smaller tube size [5][6][7] Use of i-gel [50,[63][64][65] SAD rather than tracheal tube [121,122] Video laryngoscopy [9,10] 90°rotational insertion technique, use of introducing stylet for ProSeal LMA laryngeal mask [81][82][83][84][85] Oral rather than nasotracheal intubation [124] Limiting cuff pressure [32][33][34] Cuff pressure limitation ≤ 60 cmH 2 O [88][89][90][91][92][93]96] Cuffed rather than uncuffed tubes [125] Intravenous, topical or inhaled steroids [22][23][24][25] Topical steroids, NSAIDs, tramadol [98,101,102] Limiting tracheal tube cuff pressure [126] Topical NSAIDs [27][28][29]31] Propofol induction and maintenance [106,107] SAD cuff pressure limitation ≤ 60 cmH 2 O [130][131][132][133] Liquorice, magnesium and ketami...…”

Section: Tracheal Intubation Sads Childrenmentioning

confidence: 99%

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Postoperative sore throat: a systematic review

2016

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Summary Postoperative sore throat has a reported incidence of up to 62% following general anaesthesia. In adults undergoing tracheal intubation, female sex, younger age, pre‐existing lung disease, prolonged duration of anaesthesia and the presence of a blood‐stained tracheal tube on extubation are associated with the greatest risk. Tracheal intubation without neuromuscular blockade, use of double‐lumen tubes, as well as high tracheal tube cuff pressures may also increase the risk of postoperative sore throat. The expertise of the anaesthetist performing tracheal intubation appears to have no influence on the incidence in adults, although it may in children. In adults, the i‐gel™ supraglottic airway device results in a lower incidence of postoperative sore throat. Cuffed supraglottic airway devices should be inflated sufficiently to obtain an adequate seal and intracuff pressure should be monitored. Children with respiratory tract disease are at increased risk. The use of supraglottic airway devices, oral, rather than nasal, tracheal intubation and cuffed, rather than uncuffed, tracheal tubes have benefit in reducing the incidence of postoperative sore throat in children. Limiting both tracheal tube and supraglottic airway device cuff pressure may also reduce the incidence.

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Section: Methodsmentioning

confidence: 99%

Section: Tracheal Intubation Sads Childrenmentioning

confidence: 99%

Postoperative sore throat: a systematic review

2016

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“…Chen et al . [ 20 ] observed a nearly 200% increase in CP in children receiving N 2 O even with the use of ProSeal LMA. However, Brimacombe and Berry[ 10 ] reported a self-limiting increase in CP, and Ouelette[ 3 ] reported a gradual increase in CP over 3 hours in adult patients receiving N 2 O–O 2 anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…[ 8 ] We found a higher incidence of sore throat, dysphagia and hoarseness of voice in first 24 hours post-operatively in children receiving N 2 O. Chen et al . [ 20 ] also reported a higher incidence of post-operative laryngo-tracheal morbidity in patients maintained on N 2 O–O 2 mixture. Li et al .…”

Section: Discussionmentioning

confidence: 99%

Effect of diffusion of anaesthetic gases on fibre-optic view change of laryngeal mask airway and post-operative laryngo-pharyngeal morbidity in children – A randomised controlled trial

Bharti

Bala

Lokala

et al. 2021

Indian Journal of Anaesthesia

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Background and Aims: The diffusion of nitrous oxide (N 2 O) into the air-filled cuff of the classic laryngeal mask airway (LMA) may lead to an increase in cuff pressure (CP) and displacement of LMA affecting its performance. This study was conducted to evaluate the change in optimal position of LMA by fibre-optic bronchoscope, the changes in cuff pressure and oropharyngeal leak pressure (OLP), and post-operative laryngo-pharyngeal morbidity during N 2 O–oxygen (O 2 ) anaesthesia in children. Methods: After ethics committee approval and written informed consent, 84 children, aged 2 to 8 years undergoing lower abdominal surgery using LMA were included. Anaesthesia was induced with sevoflurane and maintained with either 33% O 2 in air (Group 1) or with 33% O 2 in 67% N 2 O (Group 2) along with sevoflurane. The position of LMA using fibre-optic bronchoscope, CP and OLP were recorded at 30, 60 and 90 minutes and at the end of surgery. The incidence of post-operative sore throat, hoarseness of voice and dysphagia was assessed for 24 hours. Results: A mild (Grade 1) change in fibre-optic position of LMA was observed in 6 out of 42 children maintained with N 2 O–O 2 anaesthesia. The cuff pressure was higher than baseline in group 2 at all three time points with the maximum at 90 minutes (93.23 ± 14.86 cm H 2 O vs. 39.78 ± 7.75 cm H 2 O; P < 0.05). The OLP was comparable between the groups during the initial 60 minutes and then increased in group 2. The incidence of post-operative sore throat was significantly higher in group 2 ( P = 0.008). Conclusion: The diffusion of anaesthetic gases into the air-filled cuff does not change the fibre-optic position of the LMA significantly but increases the cuff pressure and incidence of post-operative laryngo-pharyngeal complications in children.

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“…[26] Tekin et al . recommended inflating the PLMA cuff with nitrous oxide and oxygen mixture to avoid further increase in cuff pressure when nitrous oxide was a part of general anesthesia technique.…”

Section: Discussionmentioning

confidence: 99%

ProSeal ^TM laryngeal mask airway cuff pressure changes with and without use of nitrous oxide during laparoscopic surgery

Sharma

Sehgal

Koul

et al. 2013

J Anaesthesiol Clin Pharmacol

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Background:The ProSeal™ laryngeal mask (PLMA) is increasingly being used as an airway device for laparoscopic surgery. Its silicone cuff allows diffusion of nitrous oxide, carbon dioxide and other gases with resultant rise in its intracuff pressure during anesthesia. The present study was designed to investigate the intracuff pressure changes during anesthesia with and without nitrous oxide in patients undergoing laparoscopic surgery lasting up to two hours.Materials and Methods:One hundred patients, American Society of Anesthesiologists physical status 2 and 3, undergoing general anesthesia with muscle paralysis, were randomized into two groups of 50 patients each to receive an anesthetic gas mixture containing either oxygen and nitrous oxide (group N) or oxygen and air (group A). Following insertion of an appropriate size PLMA, its cuff was inflated with air to an intracuff pressure of 45 mm Hg. The cuff pressure was measured every 10 minutes for the entire course of anesthesia. The position of the device was also assessed fiberoptically and postoperative airway complications were recorded.Results:The maximum intracuff pressure recorded in group N was 103 ± 4.7 mm Hg vs. 45.5 ± 1.5 mm Hg in group A. The percentage rise in cuff pressure every 10 minutes was also highly significant (P < 0.001) being maximum in first 10 min in group N. The incidence of postoperative airway complications was comparable between the two groups.Conclusion:The results of this study demonstrate that the intracuff pressure of the PLMA increases progressively over time when the breathing gas mixture contains nitrous oxide.

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The effect of nitrous oxide on intracuff pressure of the size 2 ProSeal Laryngeal Mask Airway

Cited by 12 publications

References 22 publications

Postoperative sore throat: a systematic review

Postoperative sore throat: a systematic review

Effect of diffusion of anaesthetic gases on fibre-optic view change of laryngeal mask airway and post-operative laryngo-pharyngeal morbidity in children – A randomised controlled trial

ProSeal ^TM laryngeal mask airway cuff pressure changes with and without use of nitrous oxide during laparoscopic surgery

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The effect of nitrous oxide on intracuff pressure of the size 2 ProSeal Laryngeal Mask Airway

Cited by 12 publications

References 22 publications

Postoperative sore throat: a systematic review

Postoperative sore throat: a systematic review

Effect of diffusion of anaesthetic gases on fibre-optic view change of laryngeal mask airway and post-operative laryngo-pharyngeal morbidity in children – A randomised controlled trial

ProSeal TM laryngeal mask airway cuff pressure changes with and without use of nitrous oxide during laparoscopic surgery

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Product

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ProSeal ^TM laryngeal mask airway cuff pressure changes with and without use of nitrous oxide during laparoscopic surgery