Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-23T02:08:39.316Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of cuff-pressure changes in LMA-Classic® and the new Soft Seal® laryngeal masks during nitrous oxide anaesthesia in spontaneous breathing patients

Published online by Cambridge University Press:  23 December 2004

A. A. J. van Zundert ,
K. Fonck ,
B. Al-Shaikh  and
E. P. Mortier
A. A. J. van Zundert
Affiliation:
Catharina Hospital, Department of Anesthesiology, Intensive Care and Pain Therapy, Eindhoven, The Netherlands
K. Fonck
Affiliation:
University Hospital Ghent, Department of Anesthesiology, Ghent, Belgium
B. Al-Shaikh
Affiliation:
William Harvey Hospital, Department of Anaesthesia, Ashford, Kent, UK
E. P. Mortier
Affiliation:
University Hospital Ghent, Department of Anesthesiology, Ghent, Belgium
Get access

Extract

Summary

Background and objective: There are concerns over the intra-cuff pressure of the laryngeal mask and laryngo-pharyngeal morbidity. In a randomized study, the authors compared cuff-pressure changes in the LMA-Classic® and the new disposable Soft Seal® laryngeal mask during nitrous oxide anaesthesia.

Methods: Two-hundred adult patients were randomly assigned to a size 4 laryngeal mask in two equal-sized groups for airway management: (a) the re-usable LMA-Classic®, or (b) the new disposable Soft Seal® laryngeal mask. Anaesthesia was administered with fentanyl, propofol, nitrous oxide, O2 and sevoflurane. The cuff pressures, adjusted to 45 mmHg at insertion, were monitored continuously until the end of the operation without any further attempt to reduce cuff pressure. On removal of the laryngeal mask, any blood at all was considered positive. Patients were requested to report any sore throat at 2 and 24 h postoperatively.

Results: During nitrous oxide anaesthesia, cuff pressures increased in the LMA-Classic® group from 45 to 100.3 mmHg and from 45 to 46.8 mmHg in the Soft Seal® laryngeal mask group (P < 0.001). The incidence of sore throat was significantly higher at 2 h postoperatively when using the LMA-Classic®, although there was no difference at 24 h following the operation. Macroscopic blood was only seen on four occasions in the LMA-Classic® group (not significant).

Conclusions: During nitrous oxide anaesthesia, cuff pressure increases in the LMA-Classic® mask were significantly higher than those of the Soft Seal® laryngeal mask. Trauma to patients, as assessed by the incidence of sore throat in the early postoperative period was significantly higher in the LMA-Classic® group. Cuff pressures should be monitored during nitrous oxide anaesthesia when LMA-Classic® is used but to do so is of less importance when using the disposable Soft Seal® laryngeal mask.

Keywords

INTUBATION, INTRATRACHEAL, laryngeal masks
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 7 , July 2004 , pp. 547 - 552
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Parker MRJ, Day CJE. Visible and occult blood contamination of laryngeal mask airways and tracheal tubes used in adult anaesthesia. Anaesthesia 2000; 55: 388–390.Google Scholar
Miller DM, Youkhana I, Karunaratne WU, Pearce A. Presence of protein deposits on ‘cleaned’ re-usable anaesthetic equipment. Anaesthesia 2001; 56: 1069–1072.Google Scholar
Tordoff SG, Scott S. Blood contamination of laryngeal mask airways and laryngoscopes – what to tell our patients? Anaesthesia 2002; 57: 505–506.Google Scholar
Chu LF, Trudell JR, Brock-Utne JG. Autoclaved reusable laryngeal mask airways contain significant protein contamination. Abstr Anesthesiol 2002; 96: A570.Google Scholar
Blunt MC, Burchett KR. Variant Creutzfeldt–Jakob disease and disposable anaesthetic equipment-balancing the risks. Br J Anaesth 2003; 90: 1–3.Google Scholar
van Zundert A, Fonck K, Al-Shaikh B, Mortier E. New single use PVC laryngeal mask – an acceptable alternative of Classic-LMA™. Eur J Anaesthesiol 2003; 20 (Suppl 30): A144.Google Scholar
Marjot R. Pressure exerted by the laryngeal mask airway cuff upon the pharyngeal mucosa. Br J Anaesth 1993; 70: 25–29.Google Scholar
Wakeling HG, Butler PJ, Baxter PJC. The laryngeal mask airway: a comparison between two insertion techniques. Anesth Analg 1997; 85: 687–690.Google Scholar
Keller C, Brimacombe J. Mucosal pressure, mechanism of seal, airway sealing pressure, and anatomic position for the disposable versus reusable laryngeal mask airways. Anesth Analg 1999; 88: 1418–1420.Google Scholar
Brimacombe J, Holyoake L, Keller C, et al. Emergence characteristics and postoperative laryngopharyngeal morbidity with the laryngeal mask airway: a comparison of high versus low initial cuff volume. Anaesthesia 2000; 55: 338–343.Google Scholar
Brimacombe J, Keller C, Morris R, Mecklem D. A comparison of the disposable versus the reusable laryngeal mask airway in paralyzed adult patients. Anesth Analg 1998; 87: 921–924.Google Scholar
Matta BF, Marsh DS, Nevin M. Laryngeal mask airway: a more successful method of insertion. J Clin Anesth 1995; 7: 132–135.Google Scholar
Dingley J, Asai T. Insertion methods of the laryngeal mask airway. A survey of current practice in Wales. Anaesthesia 1996; 51: 596–599.Google Scholar
Brimacombe J, Holyoake L, Keller C, et al. Pharyngolaryngeal, neck, and jaw discomfort after anesthesia with the face mask and laryngeal mask airway at high and low cuff volumes in males and females. Anesthesiology 2000; 93: 26–31.Google Scholar
McHardy FE, Chung F. Postoperative sore throat: cause, prevention and treatment. Anaesthesia 1999; 54: 444–453.Google Scholar
Keller C, Pühringer F, Brimacombe JR. Influence of cuff volume on oropharyngeal leak presssure and fibreoptic position with the laryngeal mask airway. Br J Anaesth 1998; 81: 186–187.Google Scholar
O'Kelly SW, Heath KJ, Lawes EG. A study of laryngeal mask inflation. Pressures exerted on the pharynx. Anaesthesia 1993; 48: 1075–1078.Google Scholar
Drage MP, Nunez J, Vaughan RS, Asai T. Jaw thrusting as a clinical test to assess the adequate depth of anaesthesia for insertion of the laryngeal mask. Anaesthesia 1996; 51: 1167–1170.Google Scholar
Brain AIJ. Pressure in laryngeal mask airway cuffs. Anaesthesia 1996; 51: 603.Google Scholar
Keller C, Brimacombe JR, Keller K, Morris R. Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients. Br J Anaesth 1999; 82: 286–287.Google Scholar
Evans NR, Gardner SV, James MFM. Proseal laryngeal mask protects against aspiration of fluid in the pharynx. Br J Anaesth 2002; 88: 584–587.Google Scholar
Brimacombe J, Berry A, Brain AIJ. Optimal intracuff pressures with the laryngeal mask. Br J Anaesth 1996; 77: 295–296.Google Scholar
Keller C, Sparr HJ, Brimacombe JR. Laryngeal mask lubrication. A comparative study of saline versus 2% lignocaine gel with cuff pressure control. Anaesthesia 1997; 52: 592–597.Google Scholar
Joshi S, Sciacca RR, Solanki DR, Young WL, Mathru MM. A prospective evaluation of clinical tests for placement of laryngeal mask airways. Anesthesiology 1998; 89: 1141–1146.Google Scholar
Figueredo E. Changes in the intracuff pressure of the laryngeal masks airway caused by repeated use. Can J Anaesth 2001; 48: 409–412.Google Scholar
Abud TM, Braz JR, Martins RH, Gregorio EA, Saldanha JC. High laryngeal mask airway pressures resulting from nitrous oxide do not increase pharyngeal mucosal injury in dogs. Can J Anaesth 2001; 48: 800–806.Google Scholar
Rieger A, Brunne B. Is the laryngeal mask a minimally invasive instrument for securing the airway? Anaesthesist 1999; 48: 399–402.Google Scholar
Chandler M. Pressure changes in tracheal tube cuffs. Anaesthesia 1986; 41: 287–293.Google Scholar
Al-Shaikh B, Jones M, Baldwin F. Evaluation of pressure changes in a new design tracheal tube cuff, the Portex Soft Seal, during nitrous oxide anaesthesia. Br J Anaesth 1999; 83: 805–806.Google Scholar
Lumb AB, Wrigley MW. The effect of nitrous oxide on laryngeal mask cuff pressure. In vivo and vitro studies. Anaesthesia 1992; 47: 320–323.Google Scholar
Dingley J, Whitehead MJ, Wareham K. A comparative study of the incidence of sore throat with the laryngeal mask airway. Anaesthesia 1994; 49: 251–254.Google Scholar