A Comparison of Seal in Seven Supraglottic Airway Devices Using a Cadaver Model of Elevated Esophageal Pressure

Bercker, Sven; Schmidbauer, Willi; Volk, Thomas; Bogusch, Gottfried; Bubser, H.P.; Hensel, M.; Kerner, Thoralf

doi:10.1213/ane.0b013e3181602ae1

Cited by 95 publications

(76 citation statements)

References 20 publications

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“…This was shown in both cadaveric studies and in vivo studies. 22,24,25 While the PLMA and SLMA are seldom used electively for patients at risk of aspiration, the above studies suggest that the adequate seal provided will allow drainage of gastric fluid even at high intragastric pressure without increasing the risk of aspiration. This can be achieved when the airway devices are positioned correctly.…”

Section: Slma and Risk Of Aspirationmentioning

confidence: 99%

The LMA Supreme™ in 700 parturients undergoing Cesarean delivery: an observational study

Yao¹,

Li²,

Sng

et al. 2012

Can J Anesth/J Can Anesth

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Background The LMA Supreme TM (SLMA) is a singleuse supraglottic device that provides a good seal for positive pressure ventilation. It has a double aperture design that facilitates the introduction of an orogastric tube to aspirate gastric contents. This observational study evaluated the role of the SLMA in parturients undergoing Cesarean delivery under general anesthesia. Methods Non-obese parturients with at least four hours of fasting and antacid prophylaxis scheduled for uncomplicated Cesarean delivery were recruited from June 2009 through May 2010 at the Quanzhou Women's and Children's Hospital, China. We recorded the number of SLMA insertion attempts, the time to effective ventilation, the incidence of aspiration, and other anesthetic and obstetric outcomes. Postoperatively, we noted the presence of blood on the SLMA, postoperative sore throat, and patient satisfaction. Analysis included comparison of results between parturients having elective and urgent Cesarean delivery. Results We recruited 700 parturients (576 elective, 124 urgent). Mean (standard deviation) body mass index was 25.6 (2.5) kgÁm -2 . All SLMA insertions were successful, with 686 (98%) inserted on first attempt and a time to effective airway of 19.5 (3.9) sec. We maintained ventilation and oxygenation in all parturients with a good seal and there was no evidence of aspiration. Eighteen parturients (2.6%) had blood on the SLMA upon removal, 24 (3.4%) had sore throat, and patient satisfaction was 85 (7)%. These results were similar in elective and urgent cases. Conclusions In a carefully selected group of parturients, the SLMA is a useful alternative to tracheal intubation for Cesarean delivery, providing effective ventilation and a low incidence of side effects or complications.

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Section: Slma and Risk Of Aspirationmentioning

confidence: 99%

The LMA Supreme™ in 700 parturients undergoing Cesarean delivery: an observational study

Yao¹,

Li²,

Sng

et al. 2012

Can J Anesth/J Can Anesth

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“…Esophageal pressure during vomiting or regurgitation was postulated to be 60 to 105 cmH 2 O, although it has not been extensively studied. [24,25] To simulate a more clinically urgent situation in terms of the occurrence of pulmonary aspiration, we used an esophageal pressure of 130 cmH 2 O, which was equal to that used by Bercker et al [26] In summary, prevention of aspiration of gastric contents was diffi cult in the semi-lateral position within clinically relevant ranges when placing the head in the neutral, simple extension, and sniffing positions. The lateral or excessive semi-lateral position was necessary to protect the trachea and lung from aspiration.…”

Section: Discussionmentioning

confidence: 99%

Prevention of aspiration of gastric contents during attempt in tracheal intubation in the semi-lateral and lateral positions

Takenaka

Aoyama²

2016

World Journal of Emergency Medicine

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BACKGROUND: Pulmonary aspiration of gastric contents during tracheal intubation is a lifethreatening complication in emergency patients. Rapid sequence intubation is commonly performed to prevent aspiration but is not associated with low risk of intubation related complications. Although it has been considered that aspiration can be prevented in the lateral position, few studies have evaluated the ability to prevent aspiration. Moreover, this position is not always a favorable position for tracheal intubation. If aspiration can be prevented in a clinically relevant semi-lateral position, it may be advantageous. We assessed the ability to prevent aspiration in the lateral position and various degrees of the semi-lateral position using a vomiting-regurgitation manikin model. METHODS:A manikin's head was placed in the neutral, simple extension, or sniffing position. The amount of aspirated saline into the bronchi during simulated vomiting was measured at semilateral position angles of 0º to 90º in 10º increments. The difference in the vertical height between the mouth corner and the inferior border of the vocal cord was measured radiologically at each semilateral position in the three head-neck positions.RESULTS: Pulmonary aspiration was prevented at the ≥70º, ≥80º, and 90º semi-lateral positions in the neutral, simple extension, and sniffi ng positions, respectively. The mouth was lower than the vocal cord in the semi-lateral position in which aspiration was prevented. CONCLUSION:The lateral or excessive semi-lateral position was necessary to protect the lung from aspiration in the head-neck positions commonly used for tracheal intubation. Prevention of aspiration was diffi cult within clinically relevant semi-lateral positions.

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“…13 While the design of the King LT, specifically the distal esophageal cuff, isolates the stomach more effectively than the laryngeal mask supraglottic airway, 23 pulmonary aspiration of gastric contents is still possible. In our cohort, the incidence of pulmonary aspiration was 2%.…”

Section: Discussionmentioning

confidence: 99%

Definitive airway management of patients presenting with a pre-hospital inserted King LT(S)-D™ laryngeal tube airway: a historical cohort study

Subramanian

Garcia‐Marcinkiewicz

Brown

et al. 2015

Can J Anesth/J Can Anesth

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A Comparison of Seal in Seven Supraglottic Airway Devices Using a Cadaver Model of Elevated Esophageal Pressure

Cited by 95 publications

References 20 publications

The LMA Supreme™ in 700 parturients undergoing Cesarean delivery: an observational study

The LMA Supreme™ in 700 parturients undergoing Cesarean delivery: an observational study

Prevention of aspiration of gastric contents during attempt in tracheal intubation in the semi-lateral and lateral positions

Definitive airway management of patients presenting with a pre-hospital inserted King LT(S)-D™ laryngeal tube airway: a historical cohort study

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