Fewer sore throats and a better seal: why routine manometry for laryngeal mask airways must become the standard of care

Bick, Edgar M.; Bailes, I.; Patel, Anil; Brain, A. I. J.

doi:10.1111/anae.12902

Cited by 45 publications

(41 citation statements)

References 39 publications

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“…They were also unaware of correct inflation pressures and of any evidence of harm. 16 This is also evident in our study. The inflation of LMAs with a predetermined volume of air is a common teaching.…”

Section: Discussionsupporting

confidence: 87%

Intraoperative management of ETT and LMA cuff pressures: a survey of anaesthetists’ knowledge, attitude and current practice

Castro

Gopalan

2016

Southern African Journal of Anaesthesia and Analgesia

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Background: Endotracheal tubes and laryngeal mask airway devices are routinely used during anaesthesia. Inappropriate inflation of cuffs has been shown to cause postoperative airway morbidity, and limiting the pressure decreases the incidence of pharyngo-laryngeal complications. Subjective measurements of cuff pressures correlate poorly to actual pressures, yet the use of objective cuff manometry is not routinely practised. The aim of this study was to determine current clinical practice of cuff inflation as well as the knowledge and attitude of anaesthetists in the University of KwaZulu-Natal (UKZN) Discipline of Anaesthesiology and Critical Care. Methods: This was a descriptive, observational study and data were collected using an anonymous self-administered questionnaire from practising anaesthetists in the UKZN Discipline of Anaesthesiology and Critical Care. Results: A total of 160 anaesthetists participated. The minimal occlusive volume test (38.8%) and the pilot balloon palpation technique (36.3%) were most commonly used. Most participants felt it was important to accurately measure ETT (84.8%) and LMA (56.1%) cuff pressures and that using a cuff manometer should be mandatory (76%). Reasons for not using it routinely included manometers not being readily available. Gaps in knowledge and education were also identified. Conclusion: There is increasing importance placed on quality assurance. Clinical practice varies widely among practitioners with the only consistency being the omission of cuff manometers during routine intraoperative management, despite their proven benefit and efficacy. The authors propose recommendations to facilitate the routine intraoperative use of cuff manometers.

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Section: Discussionsupporting

confidence: 87%

Intraoperative management of ETT and LMA cuff pressures: a survey of anaesthetists’ knowledge, attitude and current practice

Castro

Gopalan

2016

Southern African Journal of Anaesthesia and Analgesia

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“…Cuff pressure manometers should be used to avoid exceeding manufacturers' recommended intracuff pressures which can be associated with increased patient morbidity. When using devices where manufacturers do not specify or recommended a maximum cuff pressure, there may still be benefit in avoiding high pressure inflation, as this is associated with reduced morbidity and improved device performance 19.…”

Section: Anaesthetic Equipmentmentioning

confidence: 99%

Recommendations for standards of monitoring during anaesthesia and recovery 2015 : Association of Anaesthetists of Great Britain and Ireland

Checketts¹,

et al. 2015

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SummaryThis guideline updates and replaces the 4th edition of the AAGBI Standards of Monitoring published in 2007. The aim of this document is to provide guidance on the minimum standards for physiological monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the United Kingdom and Ireland. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and also during transfer of anaesthetised or sedated patients. There are new sections discussing the role of monitoring depth of anaesthesia, neuromuscular blockade and cardiac output. The indications for end‐tidal carbon dioxide monitoring have been updated.

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“…After successful placement, the intracuff pressure was estimated (in cmH 2 O) by the anaesthetist as well as by the nurse using the digital palpation technique. Depending on this assessment, air was removed from the cuff, until a suspected cuff pressure less than the upper limit of 1 …”

Section: Methodsmentioning

confidence: 99%

“…Despite their ease of handling, laryngeal masks can be used inappropriately in clinical practice [1]. For example, overinflation of laryngeal mask cuffs may be harmful because of the exertion of high pressures on pharyngeal and laryngeal structures [2].…”

Section: Introductionmentioning

confidence: 99%

Digital palpation of the pilot balloon vs. continuous manometry for controlling the intracuff pressure in laryngeal mask airways

et al. 2016

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SummaryThis study compared two methods of controlling the intracuff pressure in laryngeal mask airways. One hundred and eighty patients were randomly assigned into two groups. In the first group (n = 90), after training, the intracuff pressure was controlled using digital palpation of the pilot balloon. In the second group (n = 90), continuous manometry was used to control the intracuff pressure. In the palpation group, 37% of patients experienced pharyngolaryngeal complications vs. 12% in the manometry group (p < 0.001). We conclude that the digital palpation technique is not a suitable alternative to manometry in controlling the intracuff pressure in laryngeal mask airways.

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Fewer sore throats and a better seal: why routine manometry for laryngeal mask airways must become the standard of care

Cited by 45 publications

References 39 publications

Intraoperative management of ETT and LMA cuff pressures: a survey of anaesthetists’ knowledge, attitude and current practice

Intraoperative management of ETT and LMA cuff pressures: a survey of anaesthetists’ knowledge, attitude and current practice

Recommendations for standards of monitoring during anaesthesia and recovery 2015 : Association of Anaesthetists of Great Britain and Ireland

Digital palpation of the pilot balloon vs. continuous manometry for controlling the intracuff pressure in laryngeal mask airways

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