A technique to improve the safety of laryngeal mask airway when used in lacrimal duct surgery

Abstract

Based on the results of our study, we suggest that the LMA can safely be used in lacrimal duct procedures. Using 0.01% povidone-iodine as irrigation fluid further increases the margin of safety.

Laryngeal Mask Airway Versus Endotracheal Intubation during Lacrimal Duct Stenosis Surgery in Children—A Retrospective Analysis

“…Airway management during short-term procedures such as probing, irrigating, and dilating the obstructed lacrimal duct in infants is also passed on this principle. Congenital obstruction of the lacrimal duct system is prevalent in approximately 6% of all newborns [ 8 ]. Failure of the nasolacrimal drainage system leads to overflow of tears and the risk of recurrent inflammation and chronicity [ 9 ].…”

“…Despite the short procedure time, there is a theoretical risk of aspiration. The surgical technique, including irrigation and probing of the nasolacrimal duct, poses the risk of endotracheal aspiration of irrigation solution, blood, and/or pus [ 8 ]. An increased periprocedural risk in young children also contributes to the discussion about the appropriate timing of surgery.…”

A technique to improve the safety of laryngeal mask airway when used in lacrimal duct surgery

“…Our study group included children for lacrimal duct syringing breathing spontaneously during laryngeal mask anesthesia [using classic LMA (CLMA) and flexible LMA (FLMA)]. The mechanism of seal of the respiratory tract for the FLMA and CLMA is matching for the shape whereas it is a mixture of matching shape and mucosal pressure for ProSeal LMA (PLMA) (1). The PLMA has a higher seal pressure (6-15 cmH 2 O higher than CLMA) which makes it better suited for controlled ventilation but increases the incidence of postoperative sore throat (2,3).…”

“…S ir —We read with interest the article ‘A technique to improve the safety of laryngeal mask airway when used in lacrimal duct surgery’ by Sunder and Joshi (1). All anesthesiologists know that disadvantages of the LMA include risk of aspiration and airway obstruction and many specific procedures are more difficult or impossible to complete with the LMA in place.…”

The laryngeal mask airway and suction of lacrimal duct injectate

“…S ir —I read with interest the description by Sunder and Joshi (1) of using a continuous suction catheter in the hypopharynx when lacrimal ducts are being syringed to test their patency. It undoubtedly increases safety by removing most injectate, reducing the risk of its pulmonary aspiration and so improves the safety of use of a laryngeal mask airway.…”