Background: Hyperinflation of laryngeal mask cuffs may carry the risk of airway complications. The manufacturer recommends inflating cuff until the intracuff pressure reaches 60 cmH2O, or inflate with the volume of air to not exceed the maximum recommended volume. We prospectively assessed the correlation of cuff inflating volumes and pressures, and the appropriated the cuff inflating volumes to generate an intracuff pressure of 60 cmH2O in the adult laryngeal masks from different manufacturers. Methods: Two groups of eighty patients requiring laryngeal mask size 3 and 4 during general anesthesia were randomized into 4 subgroups for each size of the laryngeal mask: Soft Seal® (Portex®), AuraOnceTM (Ambu®), LMA-ClassicTM (Teleflex®) and LMA-ProSealTM (Teleflex®). After insertion, the cuff was inflated with 5-ml increments of air up to the maximum recommended volume. After each 5-ml intracuff pressure was measured, the volume of air that generated the intracuff pressure of 60 cmH2O was recorded. Results: Mean(SD) volume of air required to achieve the intracuff pressure of 60 cmH2O in Soft Seal®, AuraOnceTM, LMA-ClassicTM, LMA-ProSealTM laryngeal mask size 3 were 11.80(1.88), 9.20(1.88), 8.95(1.50) and 13.50(2.48) ml, respectively, and these volumes in laryngeal mask size 4 were 14.45(4.12), 12.55(1.85), 11.30(1.95) and 18.20(3.47) ml, respectively. The maximum recommended volume resulted in high intracuff pressures (>60 cmH2O) in all laryngeal mask types and sizes studied. Conclusion: Pressure-volume curves of adult laryngeal masks are all in sigmoidal shape. Cuff designs and materials can effect pressure and volume correlation. Approximately half of the maximum recommended volume is required to achieve the intracuff pressure of 60 cmH2O except LMA-ProSealTM which required two-thirds of the maximum recommended volume. Trial registration: Thai Clinical Trials Registry, TCTR20150602001, May 28, 2015
Background: Hyperinflation of laryngeal mask cuffs may carry the risk of airway complications. The manufacturer recommends inflating cuff until the intracuff pressure reaches 60 cmH 2 O, or inflate with the volume of air to not exceed the maximum recommended volume. We prospectively assessed the correlation of cuff inflating volumes and pressures, and the appropriated the cuff inflating volumes to generate an intracuff pressure of 60 cmH 2 O in the adult laryngeal masks from different manufacturers. Methods: Two groups of 80 patients requiring laryngeal mask size 3 and 4 during general anesthesia were randomized into 4 subgroups for each size of the laryngeal mask: Soft Seal® (Portex®), AuraOnce™ (Ambu®), LMA-Classic™ (Teleflex®) and LMA-ProSeal™ (Teleflex®). After insertion, the cuff was inflated with 5-ml increments of air up to the maximum recommended volume. After each 5-ml intracuff pressure was measured, the volume of air that generated the intracuff pressure of 60 cmH 2 O was recorded. Results: Mean (SD) volume of air required to achieve the intracuff pressure of 60 cmH 2 O in
Background Insertion of a nasogastric tube in an anesthetized intubated patient may be difficult. A nasogastric tube is prone to coil and kink during insertion. We hypothesize that gastric biopsy forceps can be used as a flexible stylet-assisted nasogastric tube insertion. It can improve the first-attempt success rate over the conventional blind technique during nasogastric tube insertion in the anesthetized intubated patient. Methods Eighty adult patients who required intraoperative nasogastric tube insertions were randomized to the gastric biopsy forceps assisted technique (stylet group) or the conventional blind technique (control group) for insertion of a nasogastric tube. The success rates, the duration of insertion, the incidences of coiling and kinking of a nasogastric tube, and the occurrences of complications were recorded. Results The first-attempt success rate was 92.5% in the stylet group compared with 65% in the control group (P = 0.013). The overall success rate was higher in the stylet group (100% vs 85%; P = 0.026). The mean time required to insert the nasogastric tube was shorter in the stylet group (24.85 ± 9.62 vs 62.4 ± 59.38 seconds; P = 0.002). The incidences of coiling and kinking were lower in the stylet group (7.5% vs 32.5%; P = 0.005). The incidence of minor bleeding was lower in the stylet group, but not statistically significant (2.5% vs 17.5%; P = 0.057). No other complications were observed in either of the groups. Conclusion The gastric biopsy forceps-assisted nasogastric tube insertion resulted in a higher success rate, less time for insertion, and lower incidence of coiling and kinking of a nasogastric tube than the conventional blind technique in anesthetized intubated patients without serious complications. Trial registration: Thai Clinical Trials Registry (www.clinicaltrials.in.th), TCTR20141018001 (19/09/2014).
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