Laryngeal mask airway and tracheal tube cuff pressures in children: are clinical endpoints valuable for guiding inflation?

Ong, Marcus Eng Hock; Chambers, Neil; Hullet, B.; Erb, Thomas O.; Ungern‐Sternberg, Britta S. von

doi:10.1111/j.1365-2044.2008.05486.x

Cited by 48 publications

(55 citation statements)

References 36 publications

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“…Furthermore, the results of the present study show that particular care has to be taken in smaller sized LMs since small volume changes can cause large changes in intra-cuff pressure. Particular care should be taken when nitrous oxide is used, because diffusion into the LM cuff is associated with a significant increase in LM cuff pressure [9].…”

Section: Discussionmentioning

confidence: 99%

Pressure volume curves of paediatric laryngeal mask airways

Wallace¹,

Chambers

Erb

et al. 2009

Anaesthesia

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Summary Hyperinflation of the laryngeal mask airway cuff may exert high pressure on pharyngeal and laryngeal structures. In vitro data show that high intra cuff pressures may occur when inflated to only 30% of the manufacturer’s recommended maximum inflation volume. We prospectively assessed the pressure volume curves of paediatric sized laryngeal mask airways (size 1–3) in 240 consecutive children (0–15 years). Following laryngeal mask airway insertion the cuff was inflated with 1‐ml increments of air up to the maximum recommended by the manufacturer. After each ml cuff pressure was measured. At the end all cuff pressures were adjusted to 55 cmH2O. The maximum recommended volume resulted in high intracuff pressures in all laryngeal mask airway brands and sizes studied. Approximately half the maximum volume produced a cuff pressure ≥ 60 cmH2O. This occurred in all brands and all sizes studied. We recommend that cuff manometers should be used to guide inflation in paediatric laryngeal mask airways.

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Section: Discussionmentioning

confidence: 99%

Pressure volume curves of paediatric laryngeal mask airways

Wallace¹,

Chambers

Erb

et al. 2009

Anaesthesia

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“…Increased intracuff pressure, as well as the use of intermittent positive pressure ventilation, could affect laryngeal soft tissue [20,21], and Tanaka et al [12] have shown depression of defensive reflexes over a period of time when an LMA is in situ. However, the measurements in our study were performed immediately following induction of anaesthesia; care was taken to apply low cuff pressures [22] and all patients were breathing spontaneously.…”

Section: Discussionmentioning

confidence: 99%

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

et al. 2012

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SummaryWe studied the effect of intravenous lidocaine on laryngeal and respiratory reflex responses in children anaesthetised with sevoflurane. We tested the hypothesis that the incidence of laryngospasm evoked by laryngeal stimulation is temporarily diminished after the administration of lidocaine. Forty children, aged between 25 and 84 months, were anaesthetised with sevoflurane and breathed spontaneously through a laryngeal mask airway. Respiratory reflex responses were elicited by spraying distilled water onto the laryngeal mucosa at three time intervals: (i) before lidocaine was administered (baseline); (ii) at 2 min and (iii) at 10 min following the intravenous administration of a bolus of lidocaine 2 mg.kg )1 . A blinded reviewer assessed the evoked responses. The incidence of laryngospasm was reduced from 38% at baseline to 15% 2 min after lidocaine administration (p < 0.02) and 18% 10 min after lidocaine administration (p = 0.10). We conclude that intravenous lidocaine significantly reduced the incidence of laryngospasm but that the effect was short-lived. Protecting the lungs from aspiration is vitally important and is largely regulated by laryngeal and respiratory reflexes such as coughing, laryngospasm, expiration reflex, spasmodic panting and apnoea. However, exaggerated upper airway reflexes, particularly laryngospasm, have the potential to cause harm [1]. An increased incidence of laryngospasm and apnoea is observed in children compared with adults and complications resulting from hypoxaemia are more common and more severe in children [2][3][4]. Lidocaine has been demonstrated to reduce the incidence of laryngospasm in anaesthetised children [5,6]; however, its effectiveness has been questioned [7,8]. Uncertainty regarding its usefulness is partly explained by the fact that most clinical studies were underpowered to assess the relatively rare event of laryngospasm. Often more common adverse effects, such as stridor and the occurrence of hypoxaemia from whatever cause, were included in analyses assessing its incidence. Furthermore, studies examining the action of intravenous lidocaine on cough suppression during tracheal intubation revealed that the effect may only last a few minutes [9]. The potentially transient nature of this effect might make evaluation in the clinical setting difficult.

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“…It is very important to determine the optimal insertion technique as unsuccessful prolonged insertion and multiple attempts may lead to adverse events in patients. For safe and easy insertion of LMA following items should be noticed: appropriate size, partially inflated cuff [16][17][18] and a skilled person [8].The success rate of first attempt insertion using standard Brain technique is almost 79-93% [7;19-22]. Hence, many alternative techniques like rotational or reverse, fully or partially inflated cuff, change of head position, laryngoscopic guided, lateral, use of introducer and Yodfat technique have been described to improve the success rate of LMA insertion.…”

Section: Many Anesthesiologists Do Not Use the Brain Technique Properlymentioning

confidence: 99%

Comparison of Three Methods for Laryngeal Mask Airway Insertion in Adults: Standard, Lateral and Rotational

Mahmoodpoor¹

2015

Ann Clin Anal Med

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ÖzetAmaç: Laringeal Maske Havayolu (LMH) yerleştirilmesinde, başarısız, uzamış ve birden fazla deneyimler, solunum yan etkileri ve travmaya sebep olabilirler. Bu nedenle, en uygun yerleştirilme tekniğini belirlemek çok önem taşımakta-dır. Bu çalışmanın amacı, laringeal maske havayolu yerleştirilme kolaylığın-da, standart yöntem ile yatay ve dönüşümlü (rotasyonel) teknikleri karşılaştı-rılmaktır. Gereç ve Yöntem: LMH ile genel anestezi planlanan 150 erişkin hastaya, randomize şekilde ileride belirtilen üç teknikten biri uygulandi: Standart, dönüşümlü (rotasyonel) ve yatay. LMH yerleştirilme süresi, deneme sayısı ve başarı oranı tüm hastalar için kaydedildi. Bulgular: Üç grup arasında, hastaların demografik özellikleri arsında anlamlı bir fark saptanmamıştır. LMH yerleştirilme süresi ve hastaların tahriş edilmesi yatay tekniğinde önemli ölçüde daha az idi (P <0.001). LMH yerleştirilme genel başarı oranı karşılaştırılma-sında, üç grup arasında anlamlı bir fark bulunmamıştır (p değeri: 0,06). Ancak, yatay girişim grubuna karşı olumlu bir eğilim vardır. Tartışma: LMH yerleştirilmesinde yatay teknik, kolay uygulanan, ağız arkasina sıkıştırma gerektirmeyen, böylece daha az çaba ve en az komplikasyon oluşturan bir yöntem-dir. Bu yüzden bizim bu çalışmada gösterdiğimiz gibi, 90 derece rotasyonel teknik veya lateral tekniği, LMH yerleştirilmesi için en iyi yol olarak kabul edilebilir gibi görünüyor. Anahtar Kelimeler LMH; Karşılaştırma; Yerleştirilme; Teknik AbstractDetermination of an optimal Laryngeal Mask Airway (LMA) insertion technique is of great importance as unsuccessful prolonged insertion and multiple attempts are associated with adverse respiratory effects and trauma. The purpose of this study was to compare the ease of insertion of LMA using the standard approach with lateral and rotational techniques. 150 adult patients undergoing general anesthesia using LMA were randomized into one of the three mentioned techniques: standard, rotational and lateral. The time for LMA insertion, number of LMA insertion attempts and LMA insertion success rate were noted for all patients. Demographic characteristic of patients between three groups did not have significant difference. Patient movement and time for LMA insertion and time for LMA insertion was significantly less in lateral technique (P<0.001). The overall success rate for LMA insertion between three groups was not of significant difference (P= 0.06); however, there was a positive trend toward the lateral insertion group. Lateral technique is practically easy, does not require pushing toward the back of the mouth and consequently is associated with the least complications. Therefore, it seems that the 90 degrees rotational or lateral techniques might be considered as the best ways for LMA insertion.

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Laryngeal mask airway and tracheal tube cuff pressures in children: are clinical endpoints valuable for guiding inflation?

Cited by 48 publications

References 36 publications

Pressure volume curves of paediatric laryngeal mask airways

Pressure volume curves of paediatric laryngeal mask airways

The effect of intravenous lidocaine on laryngeal and respiratory reflex responses in anaesthetised children*

Comparison of Three Methods for Laryngeal Mask Airway Insertion in Adults: Standard, Lateral and Rotational

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