The laryngeal mask airway reduces blood flow in the common carotid artery bulb

Colbert, S.; O’Hanlon, Deirdre; Flanagan, Fidelma; Page, Rory; Moriarty, Denis C.

doi:10.1007/bf03011987

Cited by 21 publications

(10 citation statements)

References 11 publications

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“… 3,4,7 A recent study demonstrated that inflation of the LMA cuff results in a decrease in both the cross‐sectional area of and blood flow through the common carotid artery bulb. 8 However, no information about intracuff pressures was available in the study.…”

Section: Discussionmentioning

confidence: 99%

Effect of High Laryngeal Mask Airway Intracuff Pressure on the Laryngopharyngeal Mucosa of Dogs

et al. 2000

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Section: Discussionmentioning

confidence: 99%

Effect of High Laryngeal Mask Airway Intracuff Pressure on the Laryngopharyngeal Mucosa of Dogs

et al. 2000

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“…The cross-sectional area of both carotid arteries significantly decreased after inflation of the LMA cuff which was compensated for by an increase in flow velocity and carotid blood flow. In their subsequent study, the authors evaluated carotid artery hemodynamics in seventeen patients who had cLMA inserted for routine elective cases under general anesthesia [ 119 ]. The cross-sectional area of the carotid arteries significantly differed between cuff inflation and deflation.…”

Section: Effect Of Sgas On Cervical Vascular Structuresmentioning

confidence: 99%

Complications Associated with the Use of Supraglottic Airway Devices in Perioperative Medicine

Michálek

Donaldson

Vobrubová

et al. 2015

BioMed Research International

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Supraglottic airway devices are routinely used for airway maintenance in elective surgical procedures where aspiration is not a significant risk and also as rescue devices in difficult airway management. Some devices now have features mitigating risk of aspiration, such as drain tubes or compartments to manage regurgitated content. Despite this, the use of these device may be associated with various complications including aspiration. This review highlights the types and incidence of these complications. They include regurgitation and aspiration of gastric contents, compression of vascular structures, trauma, and nerve injury. The incidence of such complications is quite low, but as some carry with them a significant degree of morbidity the need to follow manufacturers' advice is underlined. The incidence of gastric content aspiration associated with the devices is estimated to be as low as 0.02% with perioperative regurgitation being significantly higher but underreported. Other serious, but extremely rare, complications include pharyngeal rupture, pneumomediastinum, mediastinitis, or arytenoid dislocation. Mild short-lasting adverse effects of the devices have significantly higher incidence than serious complications and involve postoperative sore throat, dysphagia, pain on swallowing, or hoarseness. Devices may have deleterious effect on cervical mucosa or vasculature depending on their cuff volume and pressure.

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“…This led the authors to abandon the KA as a primary airway and to begin to look at the effect on survival of airway choice and to the hypothesis that supraglottic airways may have a detrimental effect on cerebral perfusion. Colbert, et al demonstrated that with a laryngeal mask airway carotid flow was marginally decreased in patients with a normal perfusion state [7]. The authors were concerned that in the low perfusion state of CPR that the effect would be greater.…”

Section: Discussionmentioning

confidence: 99%

Effect of Airway Management and Impedance Threshold Device on Circulation, Survival and Neurological Outcome in Adult Out-Of-Hospital Cardiac Arrest

Chase¹,

Salvucci²,

Marino³

et al. 2014

OJEM

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Purpose: This study was designed to study the effect of early use of the King Airway (KA) and impedance threshold device (ITD) in out-of-hospital cardiac arrest on ETCO 2 as a surrogate measure of circulation, survival, and cerebral performance category (CPC) scores. After analysis of the first 9 month active period the KA was relegated to rescue airway status. Methods: This was a prospective pre-post study design. Patients >18 years with out-of-hospital cardiac caused arrest were included. Three periods were compared. In the first "non active" period conventional AHA 30/2 compression/ventilation ratio CPR was done with bag mask ventilation (BMV). No ITD was used. After advanced airway placement the compression/ventilation ratio was 10/1. In the second period continuous compressions were done. Primary airway management was a KA with an ITD. After placement of the KA the compression/ventilation ratio was 10/1. In the third period CPR reverted to 30/2 ratio with a two hand seal BMV with ITD. CPR ratio was 10/1 post endotracheal intubation (ETI) or KA. The KA was only recommended for failed BMV and ETI. Results: Survival to hospital discharge was similar in all three study periods. In Period 2 there was a strong trend to CPC scores >2. The study group hypothesized that the KA interfered with cerebral blood flow. For that reason the KA was abandoned as a primary airway. Comparing Period 1 to Period 3 there was a trend to improved survival in the bystander witnessed shockable rhythm (Utstein) subgroup, particularly if a metronome was used. ETCO2 was significantly increased in Period 2 and trended up in Period 3 when compared to Period 1. Advanced airway intervention had a highly significant negative association with survival. Conclusion: The introduction of an ITD into our system did not result in a statistically significant improvement in survival. The study groups were somewhat dissimilar. ETCO 2 trended up. When comparing Period 1 to Period 3, the bundle of care was associated with a trend towards increased survival in the Utstein subgroup, particularly with a me-D. Chase et al. 13 tronome set at 100. Multiple confounders make a definitive conclusion impossible. Advanced airways showed a significant association with poor survival outcomes. The KA was additionally associated with poor neurologic outcomes.

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The laryngeal mask airway reduces blood flow in the common carotid artery bulb

Cited by 21 publications

References 11 publications

Effect of High Laryngeal Mask Airway Intracuff Pressure on the Laryngopharyngeal Mucosa of Dogs

Effect of High Laryngeal Mask Airway Intracuff Pressure on the Laryngopharyngeal Mucosa of Dogs

Complications Associated with the Use of Supraglottic Airway Devices in Perioperative Medicine

Effect of Airway Management and Impedance Threshold Device on Circulation, Survival and Neurological Outcome in Adult Out-Of-Hospital Cardiac Arrest

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