The reinforced laryngeal mask airway for dento-alveolar surgery

Abstract

We have evaluated the reinforced laryngeal mask airway (LMA) for use during dento-alveolar surgery in 100 ASA I and II day-case patients allocated randomly to receive either a nasotracheal tube or reinforced LMA. We recorded ease of airway insertion, airway complications, quality of recovery and replies to a 24-h postoperative questionnaire. In addition, a fibreoptic assessment was made of laryngotracheal soiling, and the effect of head movement and the position of the reinforced LMA. There were no significant differences in difficulty in airway positioning or perioperative oxygen desaturation. Nineteen patients in the nasotracheal tube group had epistaxis (P = 0.001) and laryngotracheal soiling occurred in three of these patients. Two reinforced LMA were dislodged on moving into the operating theatre and in a further five patients in this group there was partial airway obstruction (compared with none in the nasotracheal tube group; P = 0.018) which was caused by downward pressure on the mandible by the surgeon. There were no differences in postoperative complications. No surgeon reported poor access to the operating field. Overall the reinforced LMA provided satisfactory conditions for this surgery but vigilance of the airway was required, especially at the time of extraction.

Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes

“…The incidence of difficulties with positioning the airway was investigated in five studies that included 496 participants [ 6 , 14 , 15 , 17 , 18 ]. By pooling the data, it was found that the incidence of difficulties with positioning the airway was similar between the FLMA and ETT groups [RR = 1.75, 95% CI = (0.70–4.40); I 2 = 17%] ( Fig 2 ).…”

“…The occurrences of sore throat at one hour and twenty-four hours postoperative were mentioned in two [ 12 , 15 ] and three [ 6 , 12 , 17 ] studies, respectively. After pooling these data, we found that the incidence of postoperative sore throat was similar between the FLMA [RR = 0.90, 95% CI = (0.13–6.18); I 2 = 90%] ( Fig 3a ) and ETT groups [RR = 0.95, 95% CI = (0.81–1.13); I 2 = 49%] ( Fig 3b ).…”

“…Nine studies that included 923 participants compared postoperative oxygen desaturation between the FLMA and ETT groups [ 6 , 7 , 13 – 19 ]. However, the definition of oxygen desaturation varied among studies, with desaturation defined as SpO 2 <95% [ 14 , 15 , 17 ], <94% [ 16 , 18 , 19 ] and <92% [ 7 ]. Some authors did not provide the definition [ 6 , 13 ].…”

Oral and maxillofacial surgery and dental rehabilitation under sedation and general anesthesia

“…For tooth extraction in children, intranasal midazolam is used alone (5), or in combination with sufentanil or ketamine (6), in many clinics. Halothane and sevoflurane (inhaled) (7)(8)(9) and propofol (intravenous) are also used (10).…”

Application of nasal flexible laryngeal mask airway in anesthesia for oral surgery

“…tient basis [2][3][4][5], and the LMA represents a potentially effective ventilation technique for use in oral surgery. However, placement of the LMA in the mouth can itself obstruct the surgical fi eld, and its applications in oral surgery have remained limited.…”