The reinforced laryngeal mask airway (RLMA) protects the airway in patients undergoing nasal surgery — an observational study of 200 patients

Ahmed, Mamoon; Vohra, Akbar

doi:10.1007/bf03017421

Cited by 39 publications

(20 citation statements)

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“…Reliable airway protection from aspiration of blood has been clearly demonstrated with the use of supraglottic devices in elective surgery. In one study of 200 patients having elective tonsillectomy 98% of patients had no or minimal contamination of the LMA, 2% had contamination in the cup of the LMA, but there was no observed soiling of the tube [32]. These results suggest that use of supraglottic airways in the pre-hospital patient population may provide good protection from airway contamination from the upper airway in the majority of patients.…”

Section: Discussionmentioning

confidence: 99%

A prospective study of physician pre-hospital anaesthesia in trauma patients: oesophageal intubation, gross airway contamination and the ‘quick look’ airway assessment

et al. 2013

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BackgroundIn trauma patients intubated in a physician-led pre-hospital trauma service we prospectively examined the rate of misplaced tracheal tubes, the presence and nature of gross airway contamination, and the value of ‘quick look’ airway assessment to identify patients with subsequent difficult laryngoscopy.MethodsPatients requiring pre-hospital intubation in a 16 month period were included. Intubation success rate, misplaced tracheal tube rate, Cormack and Lehane grade, and the presence and nature of gross airway contamination were recorded at laryngoscopy. Tube placement was verified with carbon dioxide detection and chest x-ray. After visual assessment physicians stated whether laryngoscopy was expected to be a straightforward or ‘difficult’. The assessment was compared to subsequent laryngoscopy grade.Results400 patients had attempted intubation and 399 were successfully intubated. 42 were in cardiac arrest and intubated without drugs. There were no oesophageal or misplaced tracheal tubes. Gross airway contamination was reported in 177 of 400 patients (44%), of which ¾ was from the upper airway. Unconscious patients had higher contamination rates (57%) than conscious patients (34%) (p ≤ 0.0001). As a test of difficult intubation, the ‘quick look’ generated sensitivity 0.597 and specificity 0.763 (PPV and NPV were 0.336 and 0.904 respectively).ConclusionThis study suggests that when physicians perform pre-hospital anaesthesia they have high intubation success rates and the use of ETCO2 monitoring reduces or eliminates undetected misplaced tracheal tubes. We found high rates of airway contamination; mostly blood from the upper airway. The ‘quick look’ airway assessment had some utility but is unreliable in isolation.

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Section: Discussionmentioning

confidence: 99%

A prospective study of physician pre-hospital anaesthesia in trauma patients: oesophageal intubation, gross airway contamination and the ‘quick look’ airway assessment

et al. 2013

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“…Studies placing methylene blue dye above the LMA [16, 17] and their use in ENT surgery [18] led us to hypothesise that the awake removal of the laryngeal mask airway in paediatric dental surgery would lead to fewer postoperative airway complications. We aimed to define this by noting the lowest level of peripheral arterial oxygen saturation (SpO 2 ) that was measured, and defined a statistically significant primary outcome of our study as a p‐value of 0.05 or less.…”

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confidence: 99%

A comparison of deep vs. awake removal of the laryngeal mask airway in paediatric dental daycase surgery. A randomised controlled trial

2003

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SummaryThe authors present their experience of > 1000 axillary brachial plexus blocks performed over 13 years (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002). Using a technique that involves the location of individual nerves with a nerve stimulator, the overall success rate was 97.9%, ranging from 89.7% in 1990 to 98.4% in 1998. There have been no failures, defined as the need for conversion to general anaesthesia, in the last 500 blocks. Supplementary nerve blocks at the elbow were performed in 22.2% of patients. The first author, trained and supervised by the second author, achieved similar success rates in half the time taken by the second author. The authors conclude that technique and experience are the keys to success, but that high success rates can be achieved in a short time if anaesthetists are trained by experts in regional anaesthesia.Keywords Anaesthesia; conduction, nerve block. Brachial plexus. Education. Correspondence to: T. P. Perris E-mail: tom_perris@hotmail.com Accepted: 12 April 2003 Regional anaesthesia can confer significant benefits to the patient; overall patient safety may be improved when compared with general anaesthesia [1, 2]. It is accepted that the use of regional anaesthesia can minimise the stress response, and the avoidance of opioid-related complications is an added bonus. As unashamed advocates of regional anaesthesia, we are pleased to see a recent editorial [1] that urged the greater usage of local anaesthetic techniques in an effort to provide perfect analgesia with minimal side effects. In an attempt to forestall the 'propofol is never patchy' brigade of sceptics, we wish to present the results of an audit of our database of 13 years' regional anaesthetic practice that includes data on > 1000 axillary blocks. MethodsThe authors regularly provide anaesthesia for elective hand surgery at a tertiary orthopaedic centre. The case mix is conducive to the use of axillary brachial plexus blockade as a sole technique or in combination with general anaesthesia. The majority of work is restorative surgery for rheumatic disease and release of Dupuytren's contracture.There have been several techniques described for axillary block, with reported success rates ranging from 50 to 100% [3][4][5][6]. Before the start of this series, one author (JMW) attempted three different techniques: the trans-arterial technique, the 'two needle' technique (seeking the point of maximum excursion of the hubs of needles inserted above and below the artery), the injection of a large volume of local anaesthetic having identified pulse-synchronous contractions in muscles supplied by a single nerve when using a peripheral nerve stimulator. An unacceptably high failure rate, estimated at $ 30%, was experienced. We now use a nerve stimulator technique to identify individually, by means of the characteristic twitches, the median, radial, ulnar and (if required) musculocutaneous nerves. We approach the brachial plexus at the low axillary level, i.e. just proximal to the inserti...

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“…10 This protocol was designed to detect a 4-cm H 2 O difference in oropharyngeal leak pressure, accepting alpha and beta errors of 0.05 and 0.2 respectively. According to these parameters, a total of 36 patients per group were needed.…”

Section: Methodsmentioning

confidence: 99%

Performance of the PAX press ™ vs the ProSeal™ laryngeal mask airway during general anesthesia

Lallo

Drolet

Lacroix

2007

Can J Anesth/J Can Anesth

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The reinforced laryngeal mask airway (RLMA) protects the airway in patients undergoing nasal surgery — an observational study of 200 patients

Abstract: P Pu ur rp po os se e: : The laryngeal mask airway (LMA) is used in nasal surgery but there is some concern of tracheal or laryngeal contamination with blood and secretions. We have evaluated the ability of the LMA to prevent airway contamination until full emergence from anesthesia.

Cited by 39 publications

References 10 publications

A prospective study of physician pre-hospital anaesthesia in trauma patients: oesophageal intubation, gross airway contamination and the ‘quick look’ airway assessment

A prospective study of physician pre-hospital anaesthesia in trauma patients: oesophageal intubation, gross airway contamination and the ‘quick look’ airway assessment

A comparison of deep vs. awake removal of the laryngeal mask airway in paediatric dental daycase surgery. A randomised controlled trial

Performance of the PAX press ™ vs the ProSeal™ laryngeal mask airway during general anesthesia

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