The laryngeal mask airway is effectièe (and probably safe) in selected healthy parturients for electièe Cesarean section: a prospectièe study of 1067 cases

Abstract

Purpose: To report on the use of the laryngeal mask airway (LMA) for elective Cesarean section in 1067 consecutive ASA I-II patients preferring general anesthesia.Methods: Patients were excluded if they had pharyngeal reflux, a pre-pregnancy body mass index >30, or had a known/predicted difficult airway. Patients were fasted for six hours and given ranitidine/sodium citrate. A rapid sequence induction was performed with thiopentone and suxamethonium. The LMA was inserted by experienced users. Anesthesia was maintained with N 2 O and 50% O 2 and a volatile agent. Cricoid pressure was maintained until delivery, but was relaxed if insertion/ventilation was difficult. Patients were intubated if an effective airway was not obtained within 90 sec, or SpO 2 <94%, or end-tidal CO 2 >45 mmHg. Postdelivery, vecuronium and fentanyl were administered.Results: An effective airway was obtained in 1060 (99%) patients, 1051 (98%) at the first attempt and nine (1%) at the second or third attempt. Air leakage or partial airway obstruction occurred in 22 (21%) patients, and seven (0.7%) patients required intubation. There were no episodes of hypoxia (SpO 2 <90%), aspiration, regurgitation, laryngospasm, bronchospasm or gastric insufflation. Surgical conditions were satisfactory and all APGAR scores were $7 after five minutes.

The LMA Supreme™ in 700 parturients undergoing Cesarean delivery: an observational study

“…27 Despite the low incidence of aspiration (1:667), even in the high-risk population, 28 there is still a need for prospective studies powered adequately to validate the safety of supraglottic devices in protecting against aspiration during anesthesia. Han et al 29 found no cases of aspiration in 1,060 patients who underwent elective LSCS with a LMA Classic TM , and Halaseh et al 30 found no cases of aspiration in 3,000 patients who underwent elective LSCS with a PLMA. Our data will add to the current available literature on the use of supraglottic airway devices and the risk of aspiration in parturients.…”

Is it time to revisit tracheal intubation for Cesarean delivery?

“…24 Yao's study is therefore underpowered for its primary end point. However, with the previous two series, 5,6 we now have data on 4,643 low-risk women undergoing elective CD with an LMA with no documented cases of aspiration and one case of regurgitation. It is very important to point out though that the estimate of aspiration of 1:1000 likely includes patients at higher risk for aspiration, not the carefully selected lowrisk women included in the studies of LMA in CD in whom the incidence of aspiration is probably much lower.…”

“…3,4 In 2001, Han reported the use of the LMA Classic TM in 1,067 parturients undergoing elective CD. 5 More recently, Halaseh et al described their experience using the LMA ProSeal TM (PLMA) in 3,000 women undergoing the same procedure. 6 Both studies reported no cases of aspiration, but there was one case of regurgitation.…”

“…Au début, l'inhalation du contenu gastrique était le principal facteur responsable de mortalité maternelle. Un certain nombre de modifications ont été introduites au fil des ans pour résoudre ce problème, dont la technique d'induction à séquence rapide, qui inclut une pression cricoïdienne, une absence de ventilation au masque avant l'intubation trachéale et une utilisation 5 Plus récemment, Halaseh et coll. ont décrit leur expérience du LMA ProSeal TM (PLMA) chez 3 000 femmes subissant la même intervention.…”

“…Cependant, avec les deux séries précédentes, nous disposons maintenant de données sur 4 643 femmes à faible risque subissant une césarienne programmée avec un LMA sans cas documenté d'inhalation et un cas de régurgitation. 5,6 Il est néanmoins très important de souligner que l'estimation d'un cas d'inhalation sur 1000 inclut probablement des patientes à risque plus élevé et non les femmes à faible risque d'inhalation soigneusement sélectionnées qui sont incluses dans les études du LMA dans la césarienne chez lesquelles l'incidence d'inhalation est probablement beaucoup plus faible. Ces facteurs suggéreraient qu'il faut beaucoup plus de données pour garantir la confiance dans l'innocuité du LMA, même dans la population de patientes sélectionnées de Yao et coll., qui n'est pas représentative des patientes enceintes recevant une anesthésie générale en Amérique du Nord.…”