The effect of rocuronium on ventilatory leak and sealing pressure using a supraglottic airway device: A randomized clinical trial

Abstract

Supraglottic airway devices are established tools in clinical anaesthesia practice, and short surgeries that do not require tracheal intubation is a relevant indication for the use of such devices. They can be inserted without the use of neuromuscular blocking agents and even used during mechanical ventilation. Although avoidance of neuromuscular blockade is one of the specific advantages of supraglottic devices, 1 neuromuscular blockade is sometimes required during the intraoperative period to improve surgical conditions (eg to prevent the obturator jerk during transurethral resection of bladder tumours). When neuromuscular blocking agents were administered

Time to consider supraglottic airway device oropharyngeal leak pressure measurement more objectively

“…19 Oropharyngeal leak pressure is subject to variations and is higher in supine position, head-neck-flexion and rotation; head-neck extension is associated with a decrease in OLP. 5,20 There is no credible evidence of changes in OLP by depth of anaesthesia, muscle relaxant 7 and different surgeries including laparoscopy. 10 However, the concurrent use of muscle relaxants allows expansion of the pharyngeal anatomy, thereby facilitating insertion of SAD, enabling higher OLP and lower leakage volume.…”

“…10 However, the concurrent use of muscle relaxants allows expansion of the pharyngeal anatomy, thereby facilitating insertion of SAD, enabling higher OLP and lower leakage volume. 7,10 The OLP of the LMA-Classic/Flexible (Teleflex ® ; Athlone) is usually lower than that of second generation SADs. Furthermore, less elastic and less malleable properties of polyvinyl chloride single-cuffed SADs are associated with a lower OLP compared to the silicone-based double-cuffed versions.…”

“…There is no credible evidence of changes in OLP by depth of anaesthesia, muscle relaxant 7 and different surgeries including laparoscopy 10 . However, the concurrent use of muscle relaxants allows expansion of the pharyngeal anatomy, thereby facilitating insertion of SAD, enabling higher OLP and lower leakage volume 7,10 …”

“…OLP is widely used as an outcome parameter in scientific studies compairing different SADs. Several recent and landmark studies relating to OLP have been published in this journal 4‐7 . In these five prospective randomised controlled trials, second generation SADs were compared head to head (eg LMA‐Protector ™ vs LMA‐Supreme ™ ; i‐gel ™ vs Ambu ® AuraGain ™ ) where OLP was a study outcome 6,8 .…”

“…Several recent and landmark studies relating to OLP have been published in this journal. [4][5][6][7] In these five prospective randomised controlled trials, second generation SADs were compared head to head (eg LMA-Protector ™ vs LMA-Supreme ™ ; i-gel ™ vs Ambu ® AuraGain ™ ) where OLP was a study outcome. 6,8 Other studies investigated the effect of neuromuscular blockade, 7 lateral positioning with pneumoperitoneum 5 and the addition of nitrous oxide on OLP.…”