Gastric Insufflation and the Laryngeal Mask

Brimacombe, J.; Brain, A. I. J.; Berry, Alison M.; Verghese, C.; Ferson, David

doi:10.1097/00000539-199804000-00044

Cited by 6 publications

(2 citation statements)

References 3 publications

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“…Such large tidal volumes required inspiratory pressures up to 33 cm water that far exceeds the manufacturer's recommendation of 20 cm water. 12,14 Our study differed in several important respects from those of previous investigators. [8][9][10][11] They used LMA size #3 and size #4 respectively for women and men, whereas we used the larger sizes #4 and #5.…”

Section: Discussioncontrasting

confidence: 62%

Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-classic vs. tracheal intubation

Maltby

Beriault²,

Watson³

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: The standard laryngeal mask airway LMA-Classic was designed as an alternative to the endotracheal tube (ETT) or the face mask for use with either spontaneous or positive pressure ventilation. Positive pressure ventilation may exploit leaks around the LMA cuff, leading to gastric distension and/or inadequate ventilation. We compared gastric distension and ventilation parameters with LMA vs ETT during laparoscopic cholecystectomy.Methods: One hundred and one, ASA I-II adults scheduled for elective laparoscopic cholecystectomy were randomly assigned to LMA-Classic or ETT. Patients with BMI >30 kg·m -2 , hiatus hernia or gastroesophageal reflux were excluded. Following induction of anesthesia, an in-and-out orogastric tube was passed to decompress the stomach before insertion of the LMA (women size #4, men size #5) or ETT (women 7 mm, men 8 mm). Anesthesia was maintained with isoflurane in nitrous oxide and oxygen (FIO 2 0.3-0.5), rocuronium and fentanyl. The surgeon, blinded to the type of airway, scored gastric distention 0-10 at insertion of the laparoscope and immediately before removal at the end of the surgical procedure.Results: Incidence and degree of change in gastric distension were similar in both groups. Ventilation parameters during insufflation (mean ± SD) for LMA and ETT were: S P O 2 98 ± 1 vs 98 ± 1, P ET CO 2 38 ± 4 vs 36 ± 4 mm Hg and airway pressure 21 ± 4 vs 23 ± 3 cm water. Conclusion:Positive pressure ventilation with a correctly placed LMA-Classic of appropriate size permits adequate pulmonary ventilation. Gastric distension occurs with equal frequency with either airway device.Objectif : Le masque laryngé classique (ML) a été conçu comme une solution de remplacement au tube endotrachéal (TET) ou au masque lors de ventilation à pression positive ou de ventilation spontanée. La ventilation à pression positive accentue les fuites autour du ballonnet du ML. Nous avons comparé la distension gastrique et les paramètres de la ventilation avec le ML vs le TET pendant la cholécystectomie laparoscopique.Méthode : Cent un patients d'état physique ASA I-II, dont la cholécystectomie laparoscopique avait été planifiée, ont été répartis au hasard en deux groupes : ML et TET. Les patients dont l'IMC était >30 kg·m -2 , ou qui présen-taient une hernie hiatale ou du reflux gastro-oesophagien ont été exclus de l'étude. Après l'induction de l'anesthésie, un cathéter orogastrique (placé et enlevé) a été introduit pour décompresser l'estomac avant l'insertion du ML (modèle 4 pour les femmes, 5 pour les hommes) ou un TET (7 mm pour les femmes, 8 mm pour les hommes). L'anesthésie a été maintenue avec de l'isoflurane dans un mélange de protoxyde d'azote et d'oxygène (FIO 2 0,3-0,5), du rocuronium et du fentanyl. Le chirurgien, qui ne connaît pas le type de canule utilisée, a coté la distension gastrique de 0 à 10 à l'insertion du laparoscope et immédiatement avant son retrait à la fin de l'intervention chirurgicale.Résultats : L'incidence et le degré de changement de distension gastrique ont été similaires ...

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Section: Discussioncontrasting

confidence: 62%

Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-classic vs. tracheal intubation

Maltby

Beriault²,

Watson³

et al. 2000

Can J Anesth/J Can Anesth

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“…Cases of marked gastric distension have been reported during PPV with the LMA-C [18][19][20] and, when this occurs, both the cause and its effect must be treated. Gastric inflation may also occur with the PLMA, despite its gastric drainage tube.…”

Section: Méthode : Nous Avons Réparti 209 Femmes $ 18 Ans D'état Phmentioning

confidence: 99%

LMA-Classic™ and LMA-ProSeal™ are effective alternatives to endotracheal intubation for gynecologic laparoscopy

Maltby

Beriault

Watson

et al. 2003

Can J Anesth/J Can Anesth

104

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P Pu ur rp po os se e: : To compare the laryngeal mask airways (LMA), LMAClassic™ (LMA-C) and LMA-ProSeal™ (PLMA) with the endotracheal tube (ETT) with respect to pulmonary ventilation and gastric distension during gynecologic laparoscopy. M Me et th ho od ds s: :We stratified 209 women, aged $ 18 yr, ASA physical status I-III, by body mass index as non-obese (# 30 kg·m -2 ) or obese (> 30 kg·m -2 ) and randomized them to LMA-C/PLMA or ETT groups for airway management. Anesthesia was induced with propofol, fentanyl and succinylcholine or rocuronium. In the LMA-C/PLMA group we used a size 4 LMA-C in non-obese patients and size 4 or 5 PLMA in obese patients. In the ETT group we used a cuffed 7.0 mm ETT in all patients. Anesthesia was maintained with isoflurane in nitrous oxide and 30-50% oxygen, fentanyl and neuromuscular blockade with mechanical ventilation (tidal volume 10 mL·kg -1 ). The staff surgeon, blinded to the type of airway, scored stomach size on an ordinal scale 0-10 at initial insertion of the laparoscope and immediately before the conclusion of the surgical procedure.R Re es su ul lt ts s: : There were no crossovers and no statistically significant differences between LMA-C/PLMA and ETT groups for SpO 2, P ET CO 2 or airway pressure before or during peritoneal insufflation in short (# 15 min) or long (> 15 min) periods of peritoneal inflation. Differences between groups with respect to stomach size changes during surgery were not statistically significant. C Co on nc cl lu us si io on n: : A correctly placed LMA-C or PLMA is as effective as an ETT for positive pressure ventilation without clinically important gastric distension in non-obese and obese patients. Objectif : Comparer les masques laryngés (ML), ML Classique™ (MLC) et le ML ProSeal™ (MLP), au tube endotrachéal (TET) quant à la ventilation pulmonaire et à la distension gastrique pendant la laparoscopie gynécologique. Méthode : Nous avons réparti 209 femmes, $ 18 ans, d'état physique ASA I-III, selon l'indice de masse corporelle, comme non obèses (# 30 kg·m -2 ) ou obèses (> 30 kg·m -2 ) et leur avons assigné au hasard le MLC/MLP ou le TET pour maintenir la perméabilité des voies aériennes. L'anesthésie a été induite avec du propofol, du fen-

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The Laryngeal Mask Airway (LMA)

Principles of Airway Management

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Gastric Insufflation and the Laryngeal Mask

Cited by 6 publications

References 3 publications

Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-classic vs. tracheal intubation

Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-classic vs. tracheal intubation

LMA-Classic™ and LMA-ProSeal™ are effective alternatives to endotracheal intubation for gynecologic laparoscopy

The Laryngeal Mask Airway (LMA)

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