The laryngeal mask airway and prolonged balanced regional anaesthesia

Abstract

Prolonged anaesthesia is commonly regarded as an indication for tracheal intubation and pulmonary ventilation, t,2 although there is tittle evidence to support this. The reasons given are that intubation secures the airway and ventilation prevents respiratory fatigue and failure. Intubation and ventilation, however, carry considerable morbidity 3-5 and can often be avoided.

Laryngeal mask airway cuff pressure and position during anaesthesia lasting one to two hours

“…23,24 Overinflation of the cuff can lead to displacement and there has been one report of acute cuff overinflation leading to airway obstruction.2S DLa'ing an eight-hour operation the position of the LMA remained unchanged as judged by fibreoptic laryngoscopy. 19 In summary, this current study demonstrates that a gradual increase in cuff pressure over a one-to-two-hour period during N20/O 2 anaesthesia does not cause displacement of the LMA and that the cuff pressure increase is self-limiting within this time frame. There remains no evidence to suggest that monitoring and controlling cuff pressures is beneficial or that there is an increase in pharyngeal morbidity or adverse airway events during prolonged procedures with the LMA.…”

Use of a ProSeal™ laryngeal mask airway for eight hours of unplanned abdominal surgery

“…Brimacombe and Shorney used a LMA-C for 8 h of peripheral surgery with the patient breathing spontaneously. 3 There is scant scientific evidence that prolonged LMA use is either harmful or safe. 3 In this case, when laparotomy became necessary, we saw no indication that the PLMA should be changed to a TT, as the ventilatory measurements were all excellent.…”

Laryngeal Mask or Endotracheal Intubation in Patients with Laryngeal Carcinoma

“…За повишения риск от регургитация и аспирация при продължителни операции съществуват различни съобщения в литературата. Някои автори съобщават за операции, при които е използвана ларингеална маска с продължителност над 5 часа, без да настъпи регургитация 83 . Оперативните интервенции с продължителност над 2 часа са свързани с по-голяма честота на регургитация и аспирация 84 .…”