Effect of General Anaesthesia on the Pharynx

Nandi, Paul; Charlesworth, C.H.; Taylor, Shane; Nunn, J.F.; Doré, C

doi:10.1093/bja/66.2.157

Cited by 198 publications

(96 citation statements)

References 17 publications

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“…Head and neck movements change the shape of the pharynx, 18 and this can displace the SLA device 19 ; the SLIPA is not recommended when changing the head Values are expressed as mean ± standard deviation or absolute number * Number of patients in SLIPA group is 50 because one failed insertion is included in the analysis. P \ 0.05 between groups.…”

Section: Discussionmentioning

confidence: 99%

Less perilaryngeal gas leakage with SLIPATM than with LMA-ProSealTM in paralyzed patients

Woo

Man

Kang

et al. 2010

Can J Anesth/J Can Anesth

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Purpose The aim of this study was to compare the Streamlined Liner of the Pharynx Airway (SLIPA TM ) with the ProSeal Laryngeal Mask Airway (LMA-ProSeal TM ) in mechanically ventilated paralyzed patients undergoing laparoscopic gynecologic surgery. Methods One hundred and one patients were allocated randomly to SLIPA (n = 50) or to LMA-ProSeal (n = 51) treatment groups. After induction of general anesthesia and insertion of the assigned supralaryngeal airway (SLA) device, we made note of the occurrence of any gastric insufflation and perilaryngeal leakage. We then evaluated the anatomical fit of the SLA device using a fibreoptic bronchoscope, and we assessed the airway sealing pressure and respiratory mechanics with change in head position and during peritoneal insufflation. After surgery, we evaluated the severity of postoperative sore throat and the presence of blood or regurgitated fluid on the SLA device. Results The insertion success rate, gastric insufflation, perilaryngeal leakage, anatomical fit, airway sealing pressure, respiratory mechanics, severity of sore throat, and incidence of blood and regurgitated fluid on the device were similar between the two groups. The incidence of perilaryngeal leakage with changes in the patient's head position was lower with the SLIPA group than with the LMA-ProSeal group (3/50 vs 11/51, respectively; P = 0.026). During peritoneal insufflation, perilaryngeal leakage did not occur with the SLIPA but occurred in four cases with the LMA-ProSeal (P = 0.045). Conclusion Both the SLIPA and the LMA-ProSeal can be used effectively and without severe complications in paralyzed patients undergoing laparoscopic gynecological surgery. However, the SLIPA offers the advantage of less perilaryngeal gas leakage than the LMA-ProSeal with change in head position and during insufflation of the peritoneal cavity. This trial is registered with ANZCTR (ACTRN12609000914268). RésuméObjectif L'objectif de cette e´tude e´tait de comparer le masque SLIPA TM (Streamlined Liner of the Pharynx Airway) et le masque LMA-ProSeal TM (ProSeal Laryngeal Mask Airway) chez des patientes curarise´es recevant une ventilation me´canique et subissant une chirurgie gyne´cologique par laparoscopie. Méthode Cent une patientes ont e´te´ale´atoirement re´parties en deux groupes de traitement, soit SLIPA (n = 50) et LMA-ProSeal (n = 51). Apre`s l'induction de l'anesthe´sie ge´ne´rale et l'insertion du masque supralaryngeá ttribue´, nous avons note´la survenue de toute insufflation gastrique ou fuite pe´rilarynge´e. Nous avons ensuite e´valueĺ 'ajustement anatomique du masque supralarynge´a`l'aide d'un bronchoscope a`fibres optiques, la pression de fermeture des voies ae´riennes et la me´canique respiratoire suite a`des changements de position de la teˆte et pendant l'insufflation pe´ritone´ale. Apre`s la chirurgie, nous avons e´value´la gravite´des maux de gorge postope´ratoires et la pre´sence de sang ou de liquides re´gurgite´s sur le masque supralarynge´.

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Section: Discussionmentioning

confidence: 99%

Less perilaryngeal gas leakage with SLIPATM than with LMA-ProSealTM in paralyzed patients

Woo

Man

Kang

et al. 2010

Can J Anesth/J Can Anesth

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“…Insertion of an oral airway during light anaesthesia is therefore contraindicated. Recent radiographic and MRI studies have shown that, at induction of anaesthesia, the most important cause of obstruction is not, as previously thought, posterior displacement of the tongue, but approximation of the soft palate to the posterior pharyngeal wall [4,5]. We have found that the use of a nasal airway, rather than an oral airway, helps to smooth out this difficult, initial phase of induction.…”

Section: Upper Airway Obstructionmentioning

confidence: 60%

The obstructed airway in head and neck surgery

Mason¹,

1999

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“…Because a standard mask does not fit easily onto the cheeks of edentulous patients, face mask ventilation may be hard to perform (18). The airway may also be obstructed by movement of the tongue, soft palate, and epiglottis to the rear, whereas the space for air is lessened in the oropharynx due to low muscle tone caused by general anesthesia (19). In edentulous geriatric patients, sunken cheeks may make ventilation with a mask ineffective and perhaps even impossible (20).…”

Section: Discussionmentioning

confidence: 99%

A comparison of usage of the laryngeal mask UniqueTMin denticulate and edentulate geriatric patients

et al. 2017

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Background/aim: Mask ventilation in geriatric and edentulous patients can be ineffective or even impossible because of the shape inside the patients' cheeks. For patients for whom a mask cannot be used for long, the use of a laryngeal mask can ease the administration of anesthesia. The aim of this study was to compare the use of the laryngeal mask Unique TM in denticulate and edentulate patients aged over 65 years.Materials and methods: This prospective study included patients according to the American Society of Anesthesiologists I-III classification, aged 65 years or more. The patients were divided into two groups: a dentulous group (n = 33) and an edentulous group (n = 33). The success of the first attempt of insertion, ease of insertion, time taken to insert, and oropharyngeal leak pressure were measured. After insertion of the laryngeal mask Unique TM , a researcher who was unaware of whether the patients had teeth or not conducted an oropharyngeal leak test. Results:The success rate of inserting the laryngeal mask Unique TM on the first attempt was higher in the dentulous group than in the edentulous group. Ease of insertion, time taken to insert, oropharyngeal leak pressure, and laryngopharyngeal morbidity were similar for each group. Conclusion:In this study, successful insertion of the laryngeal mask Unique TM was higher in dentulous than in edentulous patients. We conclude that this effect could have important implications for anesthesiologists managing edentulous geriatric patients with supraglottic airway devices.

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Effect of General Anaesthesia on the Pharynx

Cited by 198 publications

References 17 publications

Less perilaryngeal gas leakage with SLIPATM than with LMA-ProSealTM in paralyzed patients

Less perilaryngeal gas leakage with SLIPATM than with LMA-ProSealTM in paralyzed patients

The obstructed airway in head and neck surgery

A comparison of usage of the laryngeal mask UniqueTMin denticulate and edentulate geriatric patients

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