The Laryngeal Mask and Other Supraglottic Airways: Application to Clinical Airway Management (original) (raw)
Related papers
A new supraglottic airway device: LMA-Supreme ™ , comparison with LMA-Proseal
Acta Anaesthesiologica Scandinavica, 2009
Background and objective: The LMA-Supreme™ (S-LMA™) is a new supraglottic airway device that presents combined features of flexibility, curved structure and single use and a different cuff structure. The purpose of this study was to compare the oropharyngeal leak pressures (OLP) of LMA-Proseal™ (P-LMA™) and S-LMA™.Methods: Sixty adult patients were prospectively and randomly allocated to undergo insertion of P-LMA™ (n=30) or S-LMA™ (n=30). The cuffs were inflated until the intracuff pressure (ICP) reached 60 cm H2O. Orogastric leak pressures, insertion times, first attempt success rates, fiberoptical assessment of position, cuff pressures, orogastric tube (OGT) placement and OGT insertion times were compared. Unblinded observers collected intraoperative data and blinded observers collected post-operative data.Results: The first insertion attempts and time taken to provide an effective airway were similar between the groups. Two patients (P-LMA™, n=1; S-LMA™, n=1) were intubated due to excessive oropharyngeal leak and in one patient (P-LMA™, n=1) due to failed OGT placement. OLPs were similar (P-LMA™; 26.9±6.6 S-LMA™; 26.1±5.2). ICP increased significantly in the P-LMA™ at the 30 and 60 min during anesthesia (P-LMA™; 80.1±12.8, 92.9±14.4, S-LMA™; 68.3±10.9, 73.7±15.6). OGT placement was successful in all patients in the S-LMA™, but failed in five patients in the P-LMA™ (P=0.02). Fiberoptically determined anatomic position was better with the P-LMA™ (P=0.03).Conclusion: Our findings suggest that S-LMA™ had leak pressures similar to the P-LMA™, and this new airway device proved to be successful during both spontaneous and positive pressure ventilation.
Turkish Journal of Anesthesia and Reanimation, 2015
Original Article / Özgün Araştırma Amaç: Prospektif ve randomize olarak yapılan bu çalışmada; birincil olarak yerleştirme kolaylığı ve yerleştirme zamanı, ikincil olarak repozisyon gereksinimi, denemelerdeki başarı oranı, sPO 2 , EtCO 2 ve hemodinamik parametreler üzerine etkileri, yeterli ve güvenli havayolu sağlayabilme ve orafaringeal ve sistemik komplikasyonları açısından, laringeal maske (LMA) Klasik, LMA Klasik, LMA Fastrach and LMA Supreme'in karşılaştırılması amaçlandı. Yöntemler: Yaşları 18-70 arasında değişen, American Society of Anesthesiologists (ASA) I-II, doksan hasta randomize olarak 3 gruba ayrılarak havayolu sağlamak için LMA Klasik, LMA Fastrach ve LMA Supreme kullanıldı. Nöromüsküler bloker kullanılmadı. Belirlenen LMA aynı anestezist tarafından bispektral index %40-%60 arasındayken yerleştirildi. Bulgular: Gruplar arasında birincil sonuç olarak belirlenen yerleştirme kolaylığı ve yerleştirme zamanı açısından istatiksel olarak fark yoktu. İkincil sonuç olarak yerleştirme sırasında repozisyon gerektirme oranı LMA klasik grupta diğer gruplara göre belirgin olarak yüksek (p<0,05), alet üzerinde kan lekesi varlığı ve mukozal ödem varlığı LMA Fastrach grubunda diğer gruplara göre yüksekti (p<0,05). Sonuç: LMA Klasik, LMA Fastrach ve LMA Supreme araçlarının tümünün etkinlik ve güvenli havayolu sağlama açısından benzer olduğunu düşünmekteyiz. Fakat LMA Supreme; repozisyon gerekmemesi ve daha az orafaringeal komplikasyona yol açmasından dolayı daha avantajlı görülmektedir. Anahtar kelimeler: Laringeal maske, havayolu yönetimi, etkinlik Objective: This prospective randomised study was designed to compare the Laryngeal Mask Airway (LMA) Classic, LMA Fastrach and LMA Supreme regarding ease of insertion and insertion time as primary outcomes and reposition, success rate of trials, effects on haemodynamic parameters, provision of an adequate and safe airway, amount of leakage and oropharyngeal and systemic complications as secondary outcomes. Methods: In this clinical trial, 90 patients aged 18-70 years of American Society of Anesthesiologists (ASA) group I-II were randomised into three groups as providing airway via LMA Classic, LMA Fastrach or LMA Supreme instead of tracheal intubation. No muscle relaxant was used. The allocated LMA was inserted by the same anaesthetist; bispectral index (BIS) was between 40% and 60%. Results: There was no statistical difference among the groups regarding the ease of insertion and insertion time as primary outcomes; the incidence of repositioning during placement was significantly higher in the LMA Classic group than that in other groups (p<0.05) and the rates of bloodstain on the device as well as oropharyngeal mucosal oedema were higher in the LMA Fastrach group than those in other groups (p<0.05) as secondary outcomes. Conclusion: We suggest that LMA Classic, LMA Supreme and LMA Fastrach had similar effectiveness regarding efficiency and airway safety. However, LMA Supreme seems to be more advantageous as it is more appropriate for fewer oropharyngeal complications and there was no repositioning.
The LMA ProSeal'--a laryngeal mask with an oesophageal vent
British Journal of Anaesthesia, 2000
We describe a new laryngeal mask airway (LMA) that incorporates a second tube placed lateral to the airway tube and ending at the tip of the mask. The second tube is intended to separate the alimentary and respiratory tracts. It should permit access to or escape of fluids from the stomach and reduce the risks of gastric insufflation and pulmonary aspiration. It can also determine the correct positioning of the mask. A second posterior cuff is fitted to improve the seal. A preliminary crossover comparison with the standard mask in 30 adult female patients showed no differences in insertion, trauma or quality of airway. At 60 cm H 2 O intracuff pressure, the new LMA gave twice the seal pressure of the standard device (PϽ0.0001) and permitted blind insertion of a gastric tube in all cases. It is concluded that the new device merits further study. Br J Anaesth 2000; 84: 650-4
A new supraglottic airway device: LMA-Supreme™, comparison with LMA-Proseal™
Acta Anaesthesiologica Scandinavica, 2009
Background and objective: The LMA-Supremet (S-LMAt) is a new supraglottic airway device that presents combined features of flexibility, curved structure and single use and a different cuff structure. The purpose of this study was to compare the oropharyngeal leak pressures (OLP) of LMA-Prosealt (P-LMAt) and S-LMAt. Methods: Sixty adult patients were prospectively and randomly allocated to undergo insertion of P-LMAt (n 5 30) or S-LMAt (n 5 30). The cuffs were inflated until the intracuff pressure (ICP) reached 60 cm H 2 O. Orogastric leak pressures, insertion times, first attempt success rates, fiberoptical assessment of position, cuff pressures, orogastric tube (OGT) placement and OGT insertion times were compared. Unblinded observers collected intraoperative data and blinded observers collected post-operative data. Results: The first insertion attempts and time taken to provide an effective airway were similar between the groups. Two patients (P-LMAt, n 5 1; S-LMAt, n 5 1) were intubated due to excessive oropharyngeal leak and in one patient (P-LMAt, n 5 1) due to failed OGT placement. OLPs were similar (P-LMAt; 26.9 AE 6.6 S-LMAt; 26.1 AE 5.2). ICP increased significantly in the P-LMAt at the 30 and 60 min during anesthesia (P-LMAt; 80.1 AE 12.8, 92.9 AE 14.4, S-LMAt; 68.3 AE 10.9, 73.7 AE 15.6). OGT placement was successful in all patients in the S-LMAt, but failed in five patients in the P-LMAt (P 5 0.02). Fiberoptically determined anatomic position was better with the P-LMAt (P 5 0.03). Conclusion: Our findings suggest that S-LMAt had leak pressures similar to the P-LMAt, and this new airway device proved to be successful during both spontaneous and positive pressure ventilation.
Airway Management Using LMA‐Evaluation of Two Insertional Techniques: A Prospective Randomised Study
Texila International Journal of Public Health, 2024
The laryngeal mask airway (LMA), originally conceived as a component of anesthesiologists' airway armamentarium, has now become an indispensable airway adjunct for a broad spectrum of healthcare providers, extending to paramedics managing out-of-hospital cardiac arrest scenarios. his randomized trial compares the success rates of the traditional digital technique versus the 180-degree rotational technique for LMA insertion in patients undergoing superficial surgeries under general anesthesia. After ethical approval and informed consent, 120 healthy adults (ASA grade I-II, ages 18-65) scheduled for superficial surgeries were enrolled. Based on a pilot study, 52 cases per group were needed, with an additional 15% to account for dropouts, resulting in 60 participants per group. Exclusion criteria included emergency surgery, obesity, reflux disease, and procedures requiring prone positioning or lasting over an hour. No significant demographic or clinical differences were found between Group A (standard technique) and Group B (180-degree technique). The success rates were similar between the two techniques. However, the 180-degree technique may provide better oropharyngeal leak pressure, improving airway sealing and ventilation.
British Journal of Anaesthesia, 2005
The laryngeal tube (VBM Medizintechnik, Sulz, Germany) is a relatively new extraglottic airway, designed to secure a patent airway during either spontaneous breathing or controlled ventilation. In this review article, we have assessed the potential role of the laryngeal tube during anaesthesia and during cardiopulmonary resuscitation. There are four variations of the laryngeal tube: standard laryngeal tube, disposable laryngeal tube, laryngeal tube-Suction II and disposable laryngeal tube-Suction II. The design of the device has been revised several times. Insertion of the standard laryngeal tube is as easy as with the laryngeal mask airway classic. The laryngeal tube may provide a better sealing effect than the laryngeal mask. The incidence of complications with the two devices is similar, although the laryngeal tube may require more readjustments of its position to obtain a clear airway. Compared with the ProSealÔ laryngeal mask, the laryngeal tube may be less effective. The efficacy of the standard laryngeal tube is unclear, particularly in patients breathing spontaneously or in children. The efficacy of the laryngeal tube Suction-II and disposable devices is also not clear. From the limited number of studies and reports available, it can be concluded that the laryngeal tube is potentially useful in maintaining a clear airway during anaesthesia and cardiopulmonary resuscitation. In addition, the device may be useful as an aid to tracheal intubation.
2016
Introduction: Proseal LMA(PLMA) and LMA supreme(SLMA) are improved versions of classic LMA and offer additional safety features such as provision of better glottis seal at low mucosal pressure, presence of a drain tube which prevents gastric insufflation and thus protects against aspiration. In the present study we compared the efficacy and aspiration risk of proseal LMA and LMA supreme with LMA classic in adult anaesthetized paralysed patients. Methods: We conducted a randomised prospective study in 60 adult anaesthetized paralysed patients. The proseal LMA and LMA supreme were compared with LMA classic in terms of ease of insertion, number of attempts, insertion time & hemodynamic parameters as primary outcome. The incidence of aspiration with these LMA devices using pH paper readings from LMA tips and comparing it with gastric content pH obtained through ryle's tube, perioperative complications and cost effectiveness of the device used were evaluated as secondary outcome. Results: Ease of insertion was although more in PLMA and SLMA than CLMA but statistically comparable in all three groups. First attempt insertion was 15/20 in group 1, 18/20 in group 2 and 3 each. Second attempt insertion was 5 patients in CLMA; 2 patients in PLMA & one patient in SLMA. Median insertion time was (22.6±3.8 sec, 20.7±3.9 and in 18.9±4.2 sec) in group 1, 2 and 3 respectively. There was no case of aspiration as evidenced by LMA tip pH which remained in the range of 6-7. The cost of SLMA was found to be more in comparison to PLMA and CLMA. Incidences of intra and post-operative complications were similar in all the three groups. Conclusion: Clinically PLMA and SLMA are easier to insert than CLMA, but overall the three groups were comparable with respect to insertion characteristics, airway manipulation required, hemodynamics, risk of aspiration and perioperative complications but cost effectiveness along with clinical benefit was seen more with PLMA.