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Flexible laryngeal mask as an alternative to reinforced tracheal tube for upper chest, head and neck oncoplastic surgery

Published online by Cambridge University Press:  01 April 2008

C. Martin-Castro  and
A. Montero
C. Martin-Castro*
Affiliation:
University Hospital of Bellvitge, Department of Anaesthesiology, Barcelona, Spain
A. Montero
Affiliation:
University Hospital of Bellvitge, Department of Anaesthesiology, Barcelona, Spain
*
Correspondence to: Carmen Martin-Castro, Department of Anaesthesiology, University Hospital of Bellvitge, Feixa Llarga s/n, 08907 L’Hospitalet de Llobregat, Barcelona, Spain. E-mail: [email protected]; Tel: +34 616656534; Fax: +34 935906259
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Summary

Background and objective

The flexible laryngeal mask airway has been mostly used in spontaneous ventilated children during short procedures to avoid the risk of kinking; little information has been reported about its airway morbidity. The aim of the study was to compare this airway device with the reinforced tracheal tube in mechanically ventilated adult patients.

Methods

120 adult patients undergoing general anaesthesia for breast, head and neck oncoplastic surgery, expected to last up to 3 h, were stratified into two airway groups: flexible laryngeal mask airway (n = 60) or reinforced tracheal tube (n = 60). Within each group, patients were randomly allocated to one of the two maintenance anaesthetic subgroups: propofol (n = 30) or sevoflurane (n = 30). Ease of insertion and haemodynamic stress response to placement, ventilation and postoperative morbidity were studied.

Results

Easy insertion rate was greater for the flexible laryngeal mask airway (93% vs. 77%, P = 0.01), and the overall success in insertion rate was 100% for both groups. Haemodynamic changes were significantly higher after inserting reinforced tracheal tube (P < 0.001). Oxygen saturation and capnography were comparable in both groups but airway pressure was lower with flexible laryngeal mask airway (P = 0.002). Sore throat, cough and dysphonia were lest frequent with flexible laryngeal mask airway (P < 0.01); also more patients in this group felt comfortable. Sevoflurane gave better results in emergence time, regardless of the airway device used.

Conclusion

During anaesthesia in mechanically ventilated adult patients, both devices function adequately, are stable and protect the airway. Flexible laryngeal mask airway results in less postoperative morbidity than reinforced tracheal tube.

Keywords

LARYNGEAL MASKSTRACHEAL TUBEAIRWAYRESPIRATION ARTIFICIALANAESTHESIA GENERAL
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 4 , April 2008 , pp. 261 - 266
Copyright
Copyright © European Society of Anaesthesiology 2007

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References

1.Domino, KB, Posner, KL, Caplan, RA, Cheney, FW. Airway injury during anesthesia. Anesthesiology 1999; 91: 1703–1711.CrossRefGoogle ScholarPubMed
2.Maktabi, MA, Smith, RB, Todd, MM. Is routine endotracheal intubation as safe as we think or wish? Anesthesiology 2003; 99: 247–248.CrossRefGoogle ScholarPubMed
3.Tanaka, A, Isono, S, Ishikawa, T, Sato, J, Nishino, T. Laryngeal resistance before and after minor surgery. Anesthesiology 2003; 99: 252–258.CrossRefGoogle ScholarPubMed
4.Jaeger, JM, Durbin, Ch G. Specialized endotracheal tubes. Clin Pulm Med 2001; 8 3: 166–176.CrossRefGoogle Scholar
5.Yarrow, S, Hare, J, Robinson, KN. Recent trends in tracheal intubation: a retrospective analysis of 97 904 cases. Anaesthesia 2003; 58: 1003–1022.CrossRefGoogle ScholarPubMed
6.Brimacombe, JR. Flexible LMA for shared airway. In: Brimacombe, JR, ed. Laryngeal Mask Anesthesia: Principles and Practice, 2nd edn.Philadelphia: WB Saunders, 2005: 445–467.Google Scholar
7.Bailey, P, Brimacombe, JR, Keller, C. The flexible LMA: literature considerations and practical guide. Int Anesthesiol Clin 1998; 36 2: 111–122.CrossRefGoogle ScholarPubMed
8.Quinn, AC, Samaan, A, McAteer, EM, Moss, E, Vucevic, M. The reinforced laryngeal mask for dento-alveolar surgery. Br J Anaesth 1996; 77: 185–188.CrossRefGoogle ScholarPubMed
9.Williams, PJ, Bailey, PM. Comparison of the reinforced laryngeal mask airway and tracheal intubation for adenotonsilectomy. Br J Anaesth 1993; 70: 30–33.CrossRefGoogle Scholar
10.Webster, AC, Morley-Forster, PK, Janzer, V et al. Anesthesia for intranasal surgery: a comparison between tracheal intubation and the reinforced laryngeal mask airway. Anesth Analg 1999; 88: 421–425.Google ScholarPubMed
11.Jellish, WS, Lien, CA, Fontenot, HJ, Hall, R. The comparative effects of sevoflurane versus propofol in the induction and maintenance of anesthesia in adults patients. Anesth Analg 1996; 82: 479–485.Google Scholar
12.Keller, C, Sparr, HJ, Brimacombe, JR. Positive pressure ventilation with the laryngeal mask airway in non-paralysed patients: comparison of sevoflurane and propofol maintenance techniques. Br J Anaesth 1998; 80: 332–336.CrossRefGoogle ScholarPubMed
13.Garcia-Pedrajas, F, Monedero, P, Carrascosa, F. Modification of Brain’s technique for insertion of laryngeal mask airway. Anesth Analg 1994; 79: 1017–1027.CrossRefGoogle ScholarPubMed
14.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.CrossRefGoogle ScholarPubMed
15.Henderson, JJ, Popat, MT, Latto, IP, Pearce, AC. Difficult airway society guidelines for management of the unanticipated difficult intubation. Anaesthesia 2004; 59: 675–694.CrossRefGoogle Scholar
16.Lacau Saint Guily, J, Boisson-Bertrand, D, Monnier, P. Lésions liées à l’intubation oro- et nasotrachéale et aux techniques alternatives: lèvres, cavités buccale et nasales, pharynx, larynx, trachée, œsophage. Ann Fr Anesth Reanim 2003; 22: 81s–96s.CrossRefGoogle Scholar
17.Brimacombe, JR, Keller, C. Bleeding, dysphagia, dysphonia, dysarthria, severe sore throat, and possible recurrent laryngeal, hypoglossal, and lingual nerve injury associated with routine laryngeal mask airway management: where is the vigilance? Anesthesiology 2004; 101: 1242–1244 (Correspondence).CrossRefGoogle Scholar
18.Brimacombe, JR. Analysis of 1500 laryngeal mask uses by one anaesthetist in adults undergoing routine anaesthesia. Anaesthesia 1996; 51: 76–80.CrossRefGoogle ScholarPubMed
19.Brimacombe, JR, Keller, C. Comparison of the flexible and standard laryngeal mask airways. Can J Anaesth 1999; 46 6: 558–563.CrossRefGoogle ScholarPubMed
20.Brimacombe, JR, 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.CrossRefGoogle ScholarPubMed
21.Baird, MB, Mayor, AH, Goodwin, APL. Removal of the laryngeal mask airway: factors affecting the incidence of post-operative adverse respiratory events in 300 patients. Eur J Anaesthesiol 1999; 16: 251–256.Google ScholarPubMed
22.Brimacombe, JR. The advantages of the LMA over the tracheal tube or facemask: a meta-analysis. Can J Anaesth 1995; 42 11: 1017–1023.CrossRefGoogle ScholarPubMed