A randomised controlled trial of the effect of laryngeal mask airway manometry on postoperative sore throat in spontaneously breathing adult patients presenting for surgery at a university teaching hospital (original) (raw)
Related papers
Anesthesiology, 2010
Background: Adverse events such as pharyngolaryngeal complications are indicators of quality patient care. Use of manometry to limit the laryngeal mask airway (LMA) intracuff pressure is not currently a routine practice. This double-blind randomized trial compared pharyngolaryngeal complications in patients managed with manometers to limit the LMA intracuff pressure (Ͻ44 mmHg) with patients under routine care. Method: Two hundred consenting patients who underwent ambulatory surgery were randomly allocated to pressure-limiting and routine care groups. Anesthesia was induced with propofol and fentanyl, and maintained with desflurane in air-oxygen. An LMA was inserted, and the cuff was inflated as per usual practice. The patients breathed spontaneously. Research assistants measured the LMA intracuff pressure. In the pressure-limiting group, LMA intracuff pressure was adjusted to less than 44 mmHg. No intervention was performed in the routine care group. Sore throat, dysphonia, and dysphagia were assessed at 1, 2, and 24 h postoperatively. Composite pharyngolaryngeal complications were compared using chi-square test. Results: Baseline demographic data were comparable between groups. Mean LMA intracuff pressure was less in the pressure-limiting group versus the routine care group (40 Ϯ 6 vs. 114 Ϯ 57 mmHg, P Ͻ 0.001). The incidence of composite pharyngolaryngeal complications was significantly lower in the pressure-limiting group versus the routine care group (13.4 vs. 45.6%, P Ͻ 0.001), with a relative risk reduction of 70.6%, and a number needed to treat of three (95% CI 2.2-7.5). Conclusion: Reduction of LMA intracuff pressure to less than 44 mmHg lowers the incidence of postoperative pharyngolaryngeal complications. The LMA cuff pressures should be measured routinely using manometry, and deflating the intracuff pressure to less than 44 mmHg should be recommended as anesthetic best practice.
Use of Manometry for Laryngeal Mask Airway Reduces Postoperative Pharyngolaryngeal Adverse Events
Anesthesiology, 2010
Background: Adverse events such as pharyngolaryngeal complications are indicators of quality patient care. Use of manometry to limit the laryngeal mask airway (LMA) intracuff pressure is not currently a routine practice. This double-blind randomized trial compared pharyngolaryngeal complications in patients managed with manometers to limit the LMA intracuff pressure (Ͻ44 mmHg) with patients under routine care. Method: Two hundred consenting patients who underwent ambulatory surgery were randomly allocated to pressure-limiting and routine care groups. Anesthesia was induced with propofol and fentanyl, and maintained with desflurane in air-oxygen. An LMA was inserted, and the cuff was inflated as per usual practice. The patients breathed spontaneously. Research assistants measured the LMA intracuff pressure. In the pressure-limiting group, LMA intracuff pressure was adjusted to less than 44 mmHg. No intervention was performed in the routine care group. Sore throat, dysphonia, and dysphagia were assessed at 1, 2, and 24 h postoperatively. Composite pharyngolaryngeal complications were compared using chi-square test. Results: Baseline demographic data were comparable between groups. Mean LMA intracuff pressure was less in the pressure-limiting group versus the routine care group (40 Ϯ 6 vs. 114 Ϯ 57 mmHg, P Ͻ 0.001). The incidence of composite pharyngolaryngeal complications was significantly lower in the pressure-limiting group versus the routine care group (13.4 vs. 45.6%, P Ͻ 0.001), with a relative risk reduction of 70.6%, and a number needed to treat of three (95% CI 2.2-7.5). Conclusion: Reduction of LMA intracuff pressure to less than 44 mmHg lowers the incidence of postoperative pharyngolaryngeal complications. The LMA cuff pressures should be measured routinely using manometry, and deflating the intracuff pressure to less than 44 mmHg should be recommended as anesthetic best practice.
Background: During general anesthesia with laryngeal mask airway (LMA), cuff pressure needs to be maintained at an optimal level in order to prevent endothelial lesions and postoperative pharyngolaryngeal side effects, like cough, sore throat, hoarseness and even mucosal bleeding. This study evaluated the changes in the LMA cuff pressure after insertion with the passage of time and the effect of the increased pressure on the incidence of pharyngolaryngeal adverse effects. Methodology: Sixty patients (18-60 y) belonging to American Society of Anesthesiologists (ASA) I or II, meeting the inclusion and exclusion criteria were included in the study and were randomly grouped into Groups A and B (n=30 each). They were evaluated and educated about LMA insertion, its advantages and side effects, following which written informed consent was obtained. Pre-anesthetic evaluation was carried out. For Group A, the cuff pressure was monitored every 10 min intra-operatively from the start of surgery and maintained at 60 cmH2O throughout the surgery. In Group B the cuff was inflated to 60 cmH2O initially and the cuff pressure was recorded at the end of surgery. The volume of air removed from the cuffs was measured and any postoperative complications immediately after removal of LMA and after 24 h were recorded and tabulated. Result: The mean cuff pressure in Group A was 61.07 cmH2O. The mean cuff pressure in Group B was 108.42 cmH2O and was significantly higher than Group A (p < 0.001). The volume of air removed was also significantly higher in Group B than Group A (p < 0.001). No association of age, gender and ASA classification on the cuff pressures was observed. There were also significantly more postoperative complications in Group B than in Group A, both immediately after and 24 h after removal of LMA. Conclusion: The results of our study show that while using a laryngeal mask airway during anesthesia, continual monitoring of cuff pressure and its maintenance within the allowable limits is essential in preventing postoperative complications and reducing pharyngolaryngeal morbidity.
Indian Journal of Anaesthesia, 2016
Background and Aims: Laryngeal mask airway (LMA) cuff pressure increases when the air is used for the cuff inflation during oxygen: nitrous oxide (O 2 :N 2 O) anaesthesia, which may lead to various problems. We compared the effects of different gases for ProSeal LMA™ (PLMA) cuff inflation in adult patients for various parameters. Methods: A total of 120 patients were randomly allocated to four groups, according to composition of gases used to inflate the PLMA cuff to achieve 40 cmH 2 O cuff pressure, air (Group A), 50% O 2 :air (Group OA), 50% O 2 :N 2 O (Group ON) and 100% O 2 (Group O). Cuff pressure, cuff volume and ventilator parameters were monitored intraoperatively. Pharyngolaryngeal parameters were assessed at 1, 2 and 24 h postoperatively. Statistical analysis was performed using ANOVA, Fisher's exact test and step-wise logistic regression. Results: Cuff pressure significantly increased at 10, 15 and 30 min in Group A, OA and O from initial pressure. Cuff pressure decreased at 5 min in Group ON (36.6 ± 3.5 cmH 2 O) (P = 0.42). PLMA cuff volume increased in Group A, OA, O, but decreased in Group ON (6.16 ± 2.8 ml [P < 0.001], 4.7 ± 3.8 ml [P < 0.001], 1.4 ± 3.19 ml [P = 0.023] and − 1.7 ± 4.9 ml [P = 0.064], respectively), from basal levels. Ventilatory parameters were comparable in all four groups. There was no significant association between sore throat and cuff pressure, with odds ratio 1.002. Conclusion: Cuff inflation with 50% O 2 :N 2 O mixture provided more stable cuff pressure in comparison to air, O 2 :air, 100% O 2 during O 2 :N 2 O anaesthesia. Ventilatory parameters did not change with variation in PLMA cuff pressure. Post-operative sore throat had no correlation with cuff pressure.
Turkish journal of anaesthesiology and reanimation, 2018
The Supreme™ laryngeal mask airway (SLMA) is a supra glottic airway (SGA) device that is used as an alternative to endotracheal tubes. In the present study, we aimed to compare the use of the SLMA with normal cuff pressure and low cuff pressure, primarily for haemodynamic response. In the present study, 120 patients diagnosed with hypertension and scheduled for varicose vein or inguinal hernia operation were enrolled and 99 patients finished. Using randomization, patients were divided into two groups according to cuff pressure as a low-pressure group (Group L, 45 cm HO) and a normal-pressure group (Group N, 60 cm HO). Demographics, Mallampati score and the type and duration of surgery, heart rate (HR), mean arterial pressure (MAP), percentage of tidal volume leakage, Ppeak, Pmean, etCO, seal pressure, fibreoptic scores and postoperative adverse effects of all patients were recorded. MAP and HR values immediately and 2 minutes after SLMA insertion were significantly lower in Group L ...
IOSR Journal of Dental and Medical Sciences, 2016
Background: LMA exerts pressure on the pharyngeal mucosa which may lead to throat discomfort. Nitrous oxide is known to diffuse into air containing cavity.Nitrous oxide use causes increase in proseal LMA(PLMA)cuff pressure was proved, but whether the resulting increased cuff pressure leading to laryngopharyngeal morbidity which is clinically important remains unclear. We therefore, tested the hypothesis. Methods:Eighty patients are randomly divided into group A(O 2 +Air) and group N(O 2+ N 2 O) each containing 40 Patients using computer generated randomization list. Patients monitored during surgical procedure regarding intraoperative hemodynamic changes , increase in PLMA cuff pressure , number of deflations required and laryngopharyngeal morbidity during intra and postoperatively upto 24 hrs.PLMA cuff pressure was monitored using cuff pressure monitor[VBM Aneroid meter]. Results:There were no significant intraoperative differences between two groups air andnitrous oxide with respect to hemodynamic parameters, but statistically significant (p valve < 0.001) cuff pressure changeswith nitrous oxide use which was exceeding > 60 cms of H2O and upto six deflations to maintain pressure in PLMA were required. There was no statistically significant difference for laryngopharyngeal morbidity, probably because we have limited cuff pressure upto 60 cms of H2O in nitrous oxide group as well in laproscopic surgeries > 3 hrs. Conclusions:Our study concludes that use of cuff pressure monitoring in PLMA to maintain cuff pressure as recommended by the manufacturer probablyreduces the incidence of postoperative pharyngo-laryngeal morbidity. Cuff pressures are increased with nitrous oxide use and repeated deflation of cuff is required. Butpharyngo-laryngeal morbidity can be limited by deflation and monitoring of cuff pressure for nitrous oxide.Nitrous oxide can be safely used forlaproscopic surgeries with PLMA for surgeries lasting less than three hours .
https://www.ijrrjournal.com/IJRR\_Vol.8\_Issue.12\_Dec2021/IJRR-Abstract087.html, 2021
Introduction:-we study the intra operative evaluation of different gas mixture(oxygen 100%, O2 50%:N2O 50%, AIR on cuff pressure of PLMA. Aims and Objectives:-To study intracuff pressure changes and the change in final volume of gas mixture during inflation and deflation during intraoperative period and postoperative complications. Material and Methods:-This double blind, prospective Study was conducted in Department of Anaesthesiology, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala following approval from institutional ethical committee and written informed patient consent. The sample size of 120 patient aged 18 to 60 years, belonging to ASA physical status 1 and 2 undergoing surgery in general anesthesia with PLMA as airway device divided into three group on the basis of PMLA cuff gas mixture:-Group O-oxygen 100%, Group ON-Nitrous 50%: Oxygen 50%, Group A-Air. Results and Conclusion:-Combination of N2O and O2 resulted in decreased intracuff pressure and air lead to a slight increase in intracuff pressure with O2 providing relatively stable cuff pressures.
The effect of laryngeal mask cuff pressure on postoperative sore throat incidence
throat. Design: Pros@tiue, randomized, obsproational study. Setting: Qpwating room cf a university hospital. Patients: 200 consurutiuP adult patients requiring anesthesia for gne~ologic pm&urrv. Interventions: Anv.sthe,sia was indurad with thiopental 3-5 mg/kg, fentnnyl 2 pg/kg, upcuronium bmmidr 0.05 mg/kg, and &'urane 0.8% to 2 % and maintained with nitrous oxidr and oxygen (65 %/35 %) and mn@rane. Measurements and Main Results: In Croup 1, cuff p rpssure measurpmrnt was rantinuously pmformPd until thr Qnd of the operation. In Croup 2, 5 minutes after induction of unrsthp.sia and 2 minutp,s @tyr inswtion of the LMA, cuff p. . TPS sure 7~~1s also continuously oi%rerved and reduced to thP minimal~~re.ssurr requir?djbr airtightnes.s. In thu rrrovT room, afttrr thr ojxration, patirnts were questioned for postoperatiup sorp throat 4, 8, and 24 hours a&r th? of~eration,following a Acoringprotorol (score 0 = no romplaints, score I = minimal serf throat, scorv 2 = moderate sorp throat, score 3 = spuere sow throat: "nuuur a LMA again". Continuous monitoring of ruff p wssurv rruealrd a steady incrPa.sP of I, ,, pre,s.surr (during the first 60 minutes incrpasrs of 43 cm H,O) in Grouf) 1. In Croup 2, afttrr rekasr of air, cuff f)rpssur~s 7u~f significantly loww through thr Pntirr opalion 7uhm :. compared 7uith Group 1. In (Group I, 8patirnts claimm to haur a sorQ throat (Scorr I, n = 4; Core 2, n = 3; StvrQ 3, n = 1). In Groufi 2, no patient complained O~SOW throat. Conclusions: A sicgniJicant increase in cuJf/ _,,.)rpssurp is smn during thrjifirst 60 minutes. Thrrr minutp,s a&r ins&ion of thr la~ng~al mask, cuj'j I,.rfssurptnn.signI ,. rfssurp tnn .signI,.rfssurptnn.signcant~y IW rvdutad 7uithout any major gas knkap. Posto~~tratiuu sorp throat can bp rrdu~d 7uhun cuj pressure is continuous4 monitored and kpjjt on lo7u$re,ssurp ualu~s.
Tracheal tube and laryngeal mask cuff pressure during anaesthesia - mandatory monitoring is in need
BMC Anesthesiology, 2010
Background: To prevent endothelium and nerve lesions, tracheal tube and laryngeal mask cuff pressure is to be maintained at a low level and yet be high enough to secure air sealing. Method: In a prospective quality-control study, 201 patients undergoing surgery during anaesthesia (without the use of nitrous oxide) were included for determination of the cuff pressure of the tracheal tubes and laryngeal masks. Results: In the 119 patients provided with a tracheal tube, the median cuff pressure was 30 (range 8 -100) cm H 2 O and the pressure exceeded 30 cm H 2 O (upper recommended level) for 54 patients. In the 82 patients provided with a laryngeal mask, the cuff pressure was 95 (10 -121) cm H 2 O and above 60 cm H 2 O (upper recommended level) for 56 patients and in 34 of these patients, the pressure exceeded the upper cuff gauge limit (120 cm H 2 O). There was no association between cuff pressure and age, body mass index, type of surgery, or time from induction of anaesthesia to the time the cuff pressure was measured. Conclusion: For maintenance of epithelia flow and nerve function and at the same time secure air sealing, this evaluation indicates that the cuff pressure needs to be checked as part of the procedures involved in induction of anaesthesia and eventually checked during surgery.
2020
Background: Hyperinflation of laryngeal mask cuffs may carry the risk of airway complications. The manufacturer recommends inflating cuff until the intracuff pressure reaches 60 cmH 2 O, or inflate with the volume of air to not exceed the maximum recommended volume. We prospectively assessed the correlation of cuff inflating volumes and pressures, and the appropriated the cuff inflating volumes to generate an intracuff pressure of 60 cmH 2 O in the adult laryngeal masks from different manufacturers. Methods: Two groups of 80 patients requiring laryngeal mask size 3 and 4 during general anesthesia were randomized into 4 subgroups for each size of the laryngeal mask: Soft Seal® (Portex®), AuraOnce™ (Ambu®), LMA-Classic™ (Teleflex®) and LMA-ProSeal™ (Teleflex®). After insertion, the cuff was inflated with 5-ml increments of air up to the maximum recommended volume. After each 5-ml intracuff pressure was measured, the volume of air that generated the intracuff pressure of 60 cmH 2 O was recorded. Results: Mean (SD) volume of air required to achieve the intracuff pressure of 60 cmH 2 O in