Un ballonnet de grand volume gêne la perfusion de la muqueuse pharyngienne postérieure réalisée avec le tube d’intubation laryngée

Abstract

P Pu ur rp po os se e: : The laryngeal tube airway (LTA) is a new extraglottic airway device with a large proximal cuff that inflates in the laryngopharynx and a distal conical cuff that inflates in the hypopharynx. We determine the influence of the cuff volume and anatomic location on pharyngeal mucosal pressures for the LTA.M Me et th ho od ds s: : Fifteen fresh cadavers were studied. Microchip sensors were attached to the (anatomic location) anterior, lateral and posterior surface of the distal cuff (hypopharynx) and proximal cuff (laryngopharynx) of the size 4 LTA. Oropharyngeal leak pressure (OLP) and mucosal pressures were measured at 0-140 mL cuff volume in 20-mL increments. In addition, mucosal pressures for the proximal cuff were measured in three awake, topicalized volunteers.R Re es su ul lt ts s: : OLP and mucosal pressure at all locations increased with cuff volume (all: P < 0.01). Mucosal pressures were highest posteriorly. Mucosal pressures only exceeded 35 cm H 2 O (pharyngeal mucosal perfusion pressure) in the anterior and posterior laryngopharynx and when the cuff volume was > 80-100 mL. Mucosal pressures were similar for cadavers and awake volunteers.C Co on nc cl lu us si io on n: : Mucosal pressures for the LTA increase with cuff volume, are highest posteriorly and potentially exceed mucosal perfusion pressure when cuff volume exceeds 80-100 mL. HE laryngeal tube airway (LTA; VBM Medizintechnik GmbH, Sulz, Germany), first described by Agro et al. 1 in 1999, is a new extraglottic airway device for resuscitation and anesthesia. It consists of an airway tube with a large proximal cuff that inflates in the proximal pharynx to form an airtight seal and a distal conical cuff that inflates in the hypopharynx to prevent regurgitation and gastric insufflation. A single pilot balloon and inflation tubing inflate both cuffs. Early clinical studies suggest that there is a high insertion success rate, 2 positive pressure ventilation is fair to excellent in 88% 1084 CARDIOTHORACIC ANESTHESIA, RESPIRATION AND AIRWAY Objectif : Le tube d'intubation laryngé (TIL) est un nouvel appareil d'intubation extraglottique muni d'un grand ballonnet proximal qui

Comparison of the intubating laryngeal mask airway and laryngeal tube placement during manual in‐line stabilisation of the neck

“…A patient may be in a neutral or the sniffing position during insertion [5]. When positioned using the recommended intracuff volume of air, the pressures exerted by the cuffs of the LT against the pharyngeal mucosa are smaller than those exerted by the ILMA against the cervical spine [6]. We can thus assume that the amount of pressure exerted by the LT against the cervical vertebrae is less than that exerted by the ILMA.…”

Comparison of effects of classic LMA, cobraPLA and V-gel rabbit on QTc interval

“…In a study using silicon microchips on the supraglottic airway devices where they touch the oropharyngeal wall, Brimacombe et al showed that when mucosal perfusion pressure is higher than 34 cmH 2 O there is a reduction in capillary blood fl ow (30,31). Tissue damage occurs with a reduction in capillary blood fl ow (2).…”

A pilot study to examine the effect of the Tulip®oropharyngeal airway on ventilation immediately after mask ventilation following the induction of anaesthesia

“…We postulate that cuff under-inflation leads to inadequate anatomical displacement of the pharyngeal tissues, requiring adjunct procedures to maintain airway patency. As the accepted mucosal perfusion pressure within the oropharyngeal mucosa is 40 mmHg [11,12], a desired intracuff pressure < 50 cmH 2 O (36 mmHg) should be appropriate to allow anatomical displacement and maintain mucosal perfusion.…”